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General NPI Number Information
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NPI Number | 1407116338
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Entity Type | Organization
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Legal Business Name | FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY MONTANA PC
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 805 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-2104
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Country | US
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Telephone | 406-549-6600
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Fax | 406-549-1511
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Provider Business Mailing Address
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Address Line | 805 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-2104
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Country | US
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Telephone | 406-549-6600
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Fax | 406-549-1511
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Authorized Official
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Title or Position | OWNER
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Name | DR. RF JOHN HOLTZEN
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Credential | DMD
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Telephone | 406-549-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 12580
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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