Healthcare Provider Details

I. General information

NPI: 1942649504
Provider Name (Legal Business Name): JORDAN THOMAS DOBMEIER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 S GRANT AVE
RED LODGE MT
59068-9271
US

IV. Provider business mailing address

910 NEWPORT BEACH WAY UNIT 8
BILLINGS MT
59106-2546
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-1010
  • Fax:
Mailing address:
  • Phone: 701-640-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-5950
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5950
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: