Healthcare Provider Details

I. General information

NPI: 1689437436
Provider Name (Legal Business Name): PETER IVEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CORPORATE DR STE 204
KALISPELL MT
59901-6138
US

IV. Provider business mailing address

511 4TH AVE E
KALISPELL MT
59901-4914
US

V. Phone/Fax

Practice location:
  • Phone: 530-277-3607
  • Fax: 406-309-6141
Mailing address:
  • Phone: 530-277-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER IVEY
Title or Position: OWNER
Credential: DDS
Phone: 530-277-3607