Healthcare Provider Details

I. General information

NPI: 1326668542
Provider Name (Legal Business Name): DENNEHY & JERDE ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 SW HIGGINS AVE
MISSOULA MT
59803-1409
US

IV. Provider business mailing address

521 SW HIGGINS AVE
MISSOULA MT
59803-1409
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-0397
  • Fax:
Mailing address:
  • Phone: 406-728-0397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KAIA JERDE
Title or Position: CO-OWNER
Credential: DDS
Phone: 406-728-0397