Healthcare Provider Details

I. General information

NPI: 1457430118
Provider Name (Legal Business Name): FIRST IMPRESSIONS DENTURE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SMELTER AVE NE STE #3
GREAT FALLS MT
59404-1937
US

IV. Provider business mailing address

PO BOX 165
BLACK EAGLE MT
59414-0165
US

V. Phone/Fax

Practice location:
  • Phone: 406-216-4746
  • Fax: 406-216-4747
Mailing address:
  • Phone: 406-216-4746
  • Fax: 406-216-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN L CASTEEL
Title or Position: DENTURIST AND LLC MEMBER
Credential: LD
Phone: 406-216-4746