Healthcare Provider Details

I. General information

NPI: 1265103022
Provider Name (Legal Business Name): NICHOLAS ALEXANDER MECKFESSEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 H ST
POPLAR MT
59255-7817
US

IV. Provider business mailing address

PO BOX 1027
POPLAR MT
59255-1027
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-2300
  • Fax:
Mailing address:
  • Phone: 406-768-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD1325
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberD1325
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1325
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: