=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538070818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERIO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3817 STEPHENS AVE
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-8542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-728-8910
-----------------------------------------------------
Fax | 866-387-8689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3817 STEPHENS AVE
-----------------------------------------------------
City | MISSOULA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59801-8542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-728-8910
-----------------------------------------------------
Fax | 866-387-8689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PERIODONTIST
-----------------------------------------------------
Name | MR. JOHN REMIEN
-----------------------------------------------------
Credential | DDS, MS
-----------------------------------------------------
Telephone | 406-728-8910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------