Healthcare Provider Details

I. General information

NPI: 1053794131
Provider Name (Legal Business Name): DENNIS DEAN BIGHORN LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 CUSTER ST PUBLIC SERVICE BLDG.
WOLF POINT MT
59201-1640
US

IV. Provider business mailing address

PO BOX 1530
MILES CITY MT
59301-1530
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-1872
  • Fax: 406-653-1775
Mailing address:
  • Phone: 406-234-0234
  • Fax: 406-234-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC 989
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: