Healthcare Provider Details

I. General information

NPI: 1043686892
Provider Name (Legal Business Name): SUNSET DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE S SUITE 102
GREAT FALLS MT
59405-4334
US

IV. Provider business mailing address

417 2ND AVE SW
CONRAD MT
59425-1901
US

V. Phone/Fax

Practice location:
  • Phone: 406-952-0154
  • Fax: 406-952-0153
Mailing address:
  • Phone: 406-278-3609
  • Fax: 406-278-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1880
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1880
License Number StateMT

VIII. Authorized Official

Name: DR. SCHUYLER A VANDYKE
Title or Position: DENTIST/OWNER
Credential: DMD, FAACP
Phone: 406-952-0154