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General NPI Number Information
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NPI Number | 1780378174
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Entity Type | Organization
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Legal Business Name | MT OMS SPECIALTY DENTAL SERVICES, PLLC
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 625 HENRY CHAPPLE ST
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City | BILLINGS
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State | MT
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Zip | 59106-1839
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Country | US
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Telephone | 406-259-7438
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 54TH AVE N STE 205
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City | NASHVILLE
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State | TN
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Zip | 37209-1442
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Country | US
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Telephone | 504-638-0303
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PROVIDER
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Name | CHARLOTTE E VIAL
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Credential |
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Telephone | 504-638-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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