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General NPI Number Information
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NPI Number | 1790939932
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTISTRY OF THE ROCKIES
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 1009 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-3140
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Country | US
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Telephone | 406-549-2395
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Fax | 406-549-2437
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Provider Business Mailing Address
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Address Line | 1009 S RESERVE ST
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City | MISSOULA
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State | MT
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Zip | 59801-3140
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Country | US
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Telephone | 406-549-2395
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Fax | 406-549-2437
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH B HYLTON
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Credential | DDS
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Telephone | 406-549-2395
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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 | 2284
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License Number State | MT
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