Healthcare Provider Details

I. General information

NPI: 1811049471
Provider Name (Legal Business Name): MONTE L COOPER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH ST S
GREAT FALLS MT
59401-3618
US

IV. Provider business mailing address

PO BOX 1522
GREAT FALLS MT
59403-1522
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6950
  • Fax:
Mailing address:
  • Phone: 406-868-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number1955
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: