Healthcare Provider Details

I. General information

NPI: 1962671370
Provider Name (Legal Business Name): NORTHERN MONTANA ORAL / MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 15TH AVE S
GREAT FALLS MT
59405-5246
US

IV. Provider business mailing address

2714 15TH AVE S
GREAT FALLS MT
59405-5246
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-4322
  • Fax: 406-771-1516
Mailing address:
  • Phone: 406-727-4322
  • Fax: 406-771-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1907
License Number StateMT

VIII. Authorized Official

Name: DR. RONALD E NEAL
Title or Position: OWNER
Credential: DDS
Phone: 406-727-4322