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General NPI Number Information
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NPI Number | 1326424524
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Entity Type | Organization
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Legal Business Name | ORDELHEIDE DENTAL INC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 200 E RAILROAD BOX 837
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City | PLAINS
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State | MT
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Zip | 59859-0837
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Country | US
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Telephone | 406-826-3611
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Fax | 406-826-3614
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Provider Business Mailing Address
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Address Line | 200 E RAILROAD BOX 837
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City | PLAINS
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State | MT
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Zip | 59859-0837
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Country | US
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Telephone | 406-826-3611
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Fax | 406-826-3614
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW ORDELHEIDE
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Credential | DDS
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Telephone | 406-826-3611
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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 | 2461
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License Number State | MT
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