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General NPI Number Information
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NPI Number | 1407424179
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Entity Type | Organization
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Legal Business Name | MT WEST DENTIST PLLC
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 200 W RAILROAD AVE
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City | PLAINS
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State | MT
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Zip | 59859-7763
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Country | US
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Telephone | 406-215-4705
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Fax | 406-258-0612
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Provider Business Mailing Address
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Address Line | PO 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 | 406-215-4705
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Fax | 406-258-0612
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DANA SHERWOOD
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Credential |
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Telephone | 316-708-1685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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