Healthcare Provider Details

I. General information

NPI: 1417393752
Provider Name (Legal Business Name): WEST YELLOWSTONE DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 01/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 NORTH CANYON ST
WEST YELLOWSTONE MT
59758-9503
US

IV. Provider business mailing address

PO BOX 1966 317 NORTH CANYON ST.
WEST YELLOWSTONE MT
59758-1966
US

V. Phone/Fax

Practice location:
  • Phone: 406-646-7766
  • Fax: 406-646-1066
Mailing address:
  • Phone: 406-646-7766
  • Fax: 406-646-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RYAN DOUGLAS SMITH
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 406-646-7766