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General NPI Number Information
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NPI Number | 1689947269
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Entity Type | Individual
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Provider Name | SHADRACH ROUNDY BARNEY L.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 734 9TH ST W STE 4
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-3858
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Country | US
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Telephone | 406-892-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 218 TERRACE RD
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City | KALISPELL
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State | MT
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Zip | 59901-7432
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Country | US
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Telephone | 406-885-0184
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | 28
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License Number State | ND
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