Healthcare Provider Details

I. General information

NPI: 1245363308
Provider Name (Legal Business Name): ALFORD MARK RITTENHOUSE L.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 7TH AVE S STE D1
GREAT FALLS MT
59405-3031
US

IV. Provider business mailing address

512 FOX CT
GREAT FALLS MT
59404-3874
US

V. Phone/Fax

Practice location:
  • Phone: 406-453-5808
  • Fax: 406-453-5899
Mailing address:
  • Phone: 406-761-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number16
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: