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General NPI Number Information
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NPI Number | 1013062389
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Entity Type | Individual
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Provider Name | JERILYN V NEGVESKY DDS
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 432 E. IDAHO STREET SUITE C510
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City | KALISPELL
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State | MT
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Zip | 59901
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Country | US
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Telephone | 406-885-1804
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Fax | 415-399-0396
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Provider Business Mailing Address
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Address Line | 432 E. IDAHO STREET SUITE C510
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City | KALISPELL
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State | MT
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Zip | 59901
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Country | US
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Telephone | 406-885-1804
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Fax | 415-399-0396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40474
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License Number State | CA
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