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General NPI Number Information
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NPI Number | 1417393752
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Entity Type | Organization
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Legal Business Name | WEST YELLOWSTONE DENTAL
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 317 NORTH CANYON ST
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City | WEST YELLOWSTONE
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State | MT
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Zip | 59758-9503
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Country | US
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Telephone | 406-646-7766
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Fax | 406-646-1066
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Provider Business Mailing Address
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Address Line | PO BOX 1966 317 NORTH CANYON ST.
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City | WEST YELLOWSTONE
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State | MT
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Zip | 59758-1966
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Country | US
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Telephone | 406-646-7766
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Fax | 406-646-1066
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RYAN DOUGLAS SMITH
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Credential | DMD
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Telephone | 406-646-7766
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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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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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