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General NPI Number Information
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NPI Number | 1497992424
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Entity Type | Organization
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Legal Business Name | GLACIER DENTAL CLINIC
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 140 S CENTRAL AVE
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City | CUT BANK
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State | MT
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Zip | 59427-3298
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Country | US
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Telephone | 406-873-5222
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Fax |
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Provider Business Mailing Address
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Address Line | 519 E MAIN ST
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City | CUT BANK
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State | MT
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Zip | 59427-3015
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Country | US
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Telephone | 406-873-5670
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Fax | 406-873-2256
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Authorized Official
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Title or Position | CFO
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Name | SYLVIA BERKRAM
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Credential |
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Telephone | 406-873-5670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1843
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License Number State | MT
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