Healthcare Provider Details

I. General information

NPI: 1750386074
Provider Name (Legal Business Name): ANNE MARGARET BREUM D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 KENSINGTON AVE STE 6
MISSOULA MT
59801-5700
US

IV. Provider business mailing address

715 KENSINGTON AVE STE 6
MISSOULA MT
59801-5700
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-8591
  • Fax: 406-543-9776
Mailing address:
  • Phone: 406-543-8591
  • Fax: 406-543-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1870
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: