MEDICARE: CASEY EGBERT D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN-DEN-LIC-13391	MT

General Provider Information

NPI Number	:	1013443019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY EGBERT D.M.D

Provider Business Mailing Address
First Line	:	918 GRAND AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-3302
Country	:	US
Telephone Number	:	406-625-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 GRAND AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-3302
Country	:	US
Telephone Number	:	406-625-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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