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General NPI Number Information
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NPI Number | 1417271701
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Entity Type | Organization
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Legal Business Name | HELENA DENTURE CLINIC, PLLC
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 03/16/2010
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Provider Practice Location Address
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Address Line | 3404 COONEY DR STE 106
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City | HELENA
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State | MT
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Zip | 59602-0215
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Country | US
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Telephone | 406-442-4899
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Fax |
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Provider Business Mailing Address
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Address Line | 3404 COONEY DR STE 106
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City | HELENA
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State | MT
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Zip | 59602-0215
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Country | US
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Telephone | 406-442-4899
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. NICHOLAS AARON HANSEMANN
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Credential | L.D.
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Telephone | 406-442-4899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | 20
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License Number State | MT
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