Healthcare Provider Details

I. General information

NPI: 1255548350
Provider Name (Legal Business Name): DAVID J. SIEVERT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 4TH AVE E
POLSON MT
59860-2117
US

IV. Provider business mailing address

308 MISSION DR PO BOX 880
ST IGNATIUS MT
59865-9676
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-5541
  • Fax: 406-883-3379
Mailing address:
  • Phone: 406-745-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2228
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: