Healthcare Provider Details

I. General information

NPI: 1649424631
Provider Name (Legal Business Name): PAMELA ANN YEAGER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 DANIELSON RD
KALISPELL MT
59901-7233
US

IV. Provider business mailing address

1288 DANIELSON RD
KALISPELL MT
59901-7233
US

V. Phone/Fax

Practice location:
  • Phone: 406-253-8511
  • Fax: 406-752-8083
Mailing address:
  • Phone: 406-253-8511
  • Fax: 406-752-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number895
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: