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General NPI Number Information
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NPI Number | 1437205119
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Entity Type | Individual
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Provider Name | MISTY DAWN ROBERTSON RDH
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3700 N PERIMETER ROAD
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City | MALMSTROM AFB
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State | MT
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Zip | 59402
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Country | US
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Telephone | 406-731-2846
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1025
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City | GREAT FALLS
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State | MT
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Zip | 59403-1025
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Country | US
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Telephone | 406-781-4746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 760
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 1125
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2004015668
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License Number State | MO
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