Healthcare Provider Details

I. General information

NPI: 1831034701
Provider Name (Legal Business Name): MISSOULA ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S RESERVE ST
MISSOULA MT
59801-2117
US

IV. Provider business mailing address

705 S RESERVE ST
MISSOULA MT
59801-2117
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-1600
  • Fax:
Mailing address:
  • Phone: 406-542-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: KRISTA N SWANSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 406-542-1600