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General NPI Number Information
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NPI Number | 1558507855
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Entity Type | Organization
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Legal Business Name | DR. CONNIE SMALL
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 1050 N MERIDIAN RD
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City | KALISPELL
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State | MT
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Zip | 59901-3542
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Country | US
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Telephone | 406-755-4127
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Fax | 406-755-4034
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Provider Business Mailing Address
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Address Line | 1050 N MERIDIAN RD
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City | KALISPELL
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State | MT
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Zip | 59901-3542
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Country | US
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Telephone | 406-755-4127
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Fax | 406-755-4034
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Authorized Official
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Title or Position | OWNER
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Name | DR. CONNIE L. SMALL
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Credential | D.D.S
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Telephone | 406-755-4127
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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 | 1758
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License Number State | MT
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