Healthcare Provider Details

I. General information

NPI: 1053556084
Provider Name (Legal Business Name): KALISPELL KIDDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FOUR MILE DR STE 10
KALISPELL MT
59901-2663
US

IV. Provider business mailing address

60 FOUR MILE DR STE 10
KALISPELL MT
59901-2663
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-1142
  • Fax: 406-756-1143
Mailing address:
  • Phone: 406-756-1142
  • Fax: 406-756-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MICHELLE KRAMER
Title or Position: OWNER/ OFFICE MANAGER
Credential:
Phone: 406-730-2383