Healthcare Provider Details

I. General information

NPI: 1861326316
Provider Name (Legal Business Name): MIA KLUESNER DR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 4TH AVE E
POLSON MT
59860-2117
US

IV. Provider business mailing address

PO BOX 541
LAKESIDE MT
59922-0541
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-33335
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: