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General NPI Number Information
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NPI Number | 1578081428
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Entity Type | Organization
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Legal Business Name | 3 RIVERS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 2680 WASHBURN ST.
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City | MISSOULA
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State | MT
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Zip | 59801-7831
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Country | US
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Telephone | 406-393-3773
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Fax | 406-926-2671
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Provider Business Mailing Address
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Address Line | 2680 WASHBURN ST.
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City | MISSOULA
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State | MT
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Zip | 59801-7831
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Country | US
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Telephone | 406-393-3773
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Fax | 406-926-2671
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. ANGELLA MARIE WINTERS
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Credential |
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Telephone | 406-393-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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