=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548120975
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI PEAKS DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2025
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S 5TH ST UNIT A101
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59741-2329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-282-4011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 COLONY CT
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59741-8727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-396-1050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KACI DRAPES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-282-4011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------