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General NPI Number Information
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NPI Number | 1225485998
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Entity Type | Organization
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Legal Business Name | MONTANA CENTER FOR LASER DENTISTRY PLLC
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 6516 US HIGHWAY 93 S
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City | WHITEFISH
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State | MT
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Zip | 59937-2916
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Country | US
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Telephone | 406-862-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 6516 US HIGHWAY 93 S
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City | WHITEFISH
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State | MT
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Zip | 59937-2916
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Country | US
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Telephone | 406-862-1010
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CARRIE CLAY
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Credential |
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Telephone | 406-862-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1682
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1887
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D2274
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License Number State | MT
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