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General NPI Number Information
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NPI Number | 1417467911
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES MOBILE DENTAL HYGIENE INC
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 105 GREY WOLF TRL
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City | BOZEMAN
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State | MT
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Zip | 59718-7677
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Country | US
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Telephone | 406-581-5293
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Fax | 406-581-5293
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Provider Business Mailing Address
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Address Line | 105 GREY WOLF TRL
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City | BOZEMAN
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State | MT
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Zip | 59718-7677
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Country | US
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Telephone | 406-581-5293
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Fax | 406-763-4637
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRYSTAL SPRING
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Credential | RDH
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Telephone | 406-581-5293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | MT-1008
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License Number State | MT
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