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General NPI Number Information
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NPI Number | 1942649504
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Entity Type | Individual
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Provider Name | JORDAN THOMAS DOBMEIER DDS
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Gender | Male
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 10/27/2017
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Provider Practice Location Address
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Address Line | 606 S GRANT AVE
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City | RED LODGE
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State | MT
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Zip | 59068-9271
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Country | US
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Telephone | 406-446-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 910 NEWPORT BEACH WAY UNIT 8
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City | BILLINGS
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State | MT
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Zip | 59106-2546
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Country | US
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Telephone | 701-640-5355
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN-DEN-LIC-5950
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5950
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License Number State | MT
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