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General NPI Number Information
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NPI Number | 1699333864
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Entity Type | Organization
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Legal Business Name | K. GUYMON DENTAL, LLC
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 1301 12TH AVE S STE 100
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City | GREAT FALLS
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State | MT
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Zip | 59405-4600
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Country | US
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Telephone | 801-698-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 3RD AVE N
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City | GREAT FALLS
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State | MT
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Zip | 59401-1508
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Country | US
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Telephone | 801-698-7632
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KEVIN GUYMON
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Credential | D.D.S.
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Telephone | 801-698-7632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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