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General NPI Number Information
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NPI Number | 1154143048
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Entity Type | Organization
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Legal Business Name | 4EAGLE DENTAL GROUP PLLP
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 100 VILLAGE LN
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City | BIGFORK
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State | MT
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Zip | 59911-3711
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Country | US
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Telephone | 406-837-4806
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Fax | 406-837-4809
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Provider Business Mailing Address
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Address Line | 100 VILLAGE LN
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City | BIGFORK
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State | MT
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Zip | 59911-3711
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Country | US
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Telephone | 406-837-4806
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Fax | 406-837-4809
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Authorized Official
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Title or Position | MEMBER OWNER
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Name | DAVID KEIM
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Credential | DDS
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Telephone | 406-471-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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