Healthcare Provider Details

I. General information

NPI: 1053955963
Provider Name (Legal Business Name): HELMS FAMILY DENTAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 S HIGGINS AVE
MISSOULA MT
59801-4226
US

IV. Provider business mailing address

2200 RAFFERTY LN
MISSOULA MT
59804-6104
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-3848
  • Fax:
Mailing address:
  • Phone: 406-721-8250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: JASON HELMS
Title or Position: PRESIDENT
Credential: DMD
Phone: 406-721-8250