Healthcare Provider Details

I. General information

NPI: 1144798604
Provider Name (Legal Business Name): BILLINGS ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S 4J RD
GILLETTE WY
82716-4132
US

IV. Provider business mailing address

152 S 32ND ST W STE A
BILLINGS MT
59102-6875
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-5665
  • Fax:
Mailing address:
  • Phone: 406-245-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KEVIN CHAD LAMBOURNE
Title or Position: OWNER/PARTNER
Credential:
Phone: 406-245-4414