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General NPI Number Information
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NPI Number | 1962671370
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Entity Type | Organization
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Legal Business Name | NORTHERN MONTANA ORAL / MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 2714 15TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-5246
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Country | US
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Telephone | 406-727-4322
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Fax | 406-771-1516
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Provider Business Mailing Address
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Address Line | 2714 15TH AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405-5246
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Country | US
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Telephone | 406-727-4322
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Fax | 406-771-1516
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD E NEAL
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Credential | DDS
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Telephone | 406-727-4322
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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 | 1907
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License Number State | MT
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