Healthcare Provider Details

I. General information

NPI: 1770645095
Provider Name (Legal Business Name): CHRISTOPHER G. BRUCH D.D.S., M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PARK DR S STE 201
GREAT FALLS MT
59405-1819
US

IV. Provider business mailing address

300 PARK DR S STE 201
GREAT FALLS MT
59405-1819
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-1101
  • Fax: 406-454-1882
Mailing address:
  • Phone: 406-454-1101
  • Fax: 406-454-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1872
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: