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General NPI Number Information
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NPI Number | 1053273011
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Entity Type | Organization
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Legal Business Name | 12 ORTHODONTICS
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Dates
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Enumeration Date | 11/28/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 34 BRUYER WAY
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City | KALISPELL
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State | MT
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Zip | 59901-6305
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Country | US
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Telephone | 406-752-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 34 BRUYER WAY
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City | KALISPELL
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State | MT
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Zip | 59901-6305
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Country | US
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Telephone | 406-752-8686
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KURTIS CRANDELL BRAY
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Credential | DMD
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Telephone | 406-370-5227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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