Healthcare Provider Details

I. General information

NPI: 1902842883
Provider Name (Legal Business Name): DHARMA ROSE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GERIDHARMA OR DHARMA ROSE DEFRESE DO, MS, RPH, FAIHM

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54699 HILLSIDE RD
ST IGNATIUS MT
59865-8915
US

IV. Provider business mailing address

54699 HILLSIDE RD
ST IGNATIUS MT
59865-8915
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-0845
  • Fax: 833-918-2217
Mailing address:
  • Phone: 406-745-0845
  • Fax: 406-204-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-53457
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number02001899
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMED-PHYS-LIC-53457
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001899
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: