Healthcare Provider Details

I. General information

NPI: 1972423358
Provider Name (Legal Business Name): GREAT FALLS COLLEGE MONTANA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 16TH AVE S
GREAT FALLS MT
59405-4907
US

IV. Provider business mailing address

2100 16TH AVE S
GREAT FALLS MT
59405-4907
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-4392
  • Fax:
Mailing address:
  • Phone: 406-771-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: CARMEN L ROBERTS
Title or Position: EXEC DIR FINANCE & ADMIN
Credential:
Phone: 406-771-4392