Healthcare Provider Details

I. General information

NPI: 1841633799
Provider Name (Legal Business Name): DALLIN GREENE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

IV. Provider business mailing address

401 S ALABAMA ST STE 1011
BUTTE MT
59701-2315
US

V. Phone/Fax

Practice location:
  • Phone: 406-345-8901
  • Fax:
Mailing address:
  • Phone: 406-782-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number44493
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: