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General NPI Number Information
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NPI Number | 1487494795
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Entity Type | Individual
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Provider Name | KIERSTIN ELIZABETH SHAHTOUT DDS
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Gender | Female
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 2000 MAPLE ST STE 100
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City | MISSOULA
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State | MT
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Zip | 59808-2089
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Country | US
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Telephone | 406-919-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 7114 SHAVER DR UNIT A
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City | MISSOULA
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State | MT
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Zip | 59803-8505
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Country | US
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Telephone | 406-788-0848
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN-DEN-LIC-30828
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License Number State | MT
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