Healthcare Provider Details

I. General information

NPI: 1821328394
Provider Name (Legal Business Name): MONTANA ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MEDICAL PARK DR UNIT #1
HELENA MT
59601-8048
US

IV. Provider business mailing address

65 MEDICAL PARK DR UNIT #1
HELENA MT
59601-8048
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-3334
  • Fax:
Mailing address:
  • Phone: 406-443-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2362
License Number StateMT

VIII. Authorized Official

Name: DR. JASON FLEISCHMANN
Title or Position: OWNER
Credential: DMD, MD
Phone: 406-443-3334