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General NPI Number Information
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NPI Number | 1386315570
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Entity Type | Organization
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Legal Business Name | AD ASTRA, LLC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 736 N LAST CHANCE GULCH
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City | HELENA
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State | MT
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Zip | 59601-3319
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Country | US
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Telephone | 406-430-1143
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 E 6TH AVE
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City | HELENA
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State | MT
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Zip | 59601-4765
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Country | US
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Telephone | 406-868-4549
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUSTIN HICKS
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Credential | DMD
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Telephone | 406-868-4549
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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 |
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License Number State |
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