Healthcare Provider Details

I. General information

NPI: 1386570943
Provider Name (Legal Business Name): TODD OLDROYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203B RIDGEWATER DR STE 1
POLSON MT
59860-9194
US

IV. Provider business mailing address

203B RIDGEWATER DR STE 1
POLSON MT
59860-9194
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-6269
  • Fax: 406-883-6269
Mailing address:
  • Phone: 406-883-6269
  • Fax: 406-883-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-33418
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN-DEN-LIC-33418
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: