Healthcare Provider Details

I. General information

NPI: 1376941096
Provider Name (Legal Business Name): BC RESTORATIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SUNSET PLZ STE C
KALISPELL MT
59901-3659
US

IV. Provider business mailing address

308 MORNING VIEW DR
KALISPELL MT
59901-8167
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-3733
  • Fax: 406-752-3734
Mailing address:
  • Phone: 406-752-3733
  • Fax: 406-752-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number4206
License Number StateMT

VIII. Authorized Official

Name: MR. CARL JUSTIN BRISENDINE
Title or Position: OWNER/DENTURES
Credential: L.D.
Phone: 406-752-3733