Healthcare Provider Details

I. General information

NPI: 1417271701
Provider Name (Legal Business Name): HELENA DENTURE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 COONEY DR STE 106
HELENA MT
59602-0215
US

IV. Provider business mailing address

3404 COONEY DR STE 106
HELENA MT
59602-0215
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-4899
  • Fax:
Mailing address:
  • Phone: 406-442-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number20
License Number StateMT

VIII. Authorized Official

Name: MR. NICHOLAS AARON HANSEMANN
Title or Position: OWNER
Credential: L.D.
Phone: 406-442-4899