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General NPI Number Information
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NPI Number | 1083475701
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Entity Type | Organization
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Legal Business Name | HAVRE DENTURE LLC
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 220 3RD AVE STE 204
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City | HAVRE
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State | MT
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Zip | 59501-3554
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Country | US
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Telephone | 406-262-7722
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Fax | 406-262-7723
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Provider Business Mailing Address
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Address Line | 220 3RD AVE STE 204
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City | HAVRE
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State | MT
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Zip | 59501-3554
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Country | US
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Telephone | 406-262-7722
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Fax | 406-262-7723
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | FABIONE OLMSTEAD
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Credential | ATC, LAT
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Telephone | 406-262-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number |
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License Number State |
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