Healthcare Provider Details

I. General information

NPI: 1437573003
Provider Name (Legal Business Name): CASCADE FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 6TH AVE S
GREAT FALLS MT
59405-3013
US

IV. Provider business mailing address

PO BOX 36
SUN RIVER MT
59483-0036
US

V. Phone/Fax

Practice location:
  • Phone: 406-315-8004
  • Fax: 406-315-8003
Mailing address:
  • Phone: 406-315-8004
  • Fax: 406-315-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6079
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. LEIGHTON ROGER HOLLEY III
Title or Position: MANAGER
Credential: DDS
Phone: 406-315-8004