MEDICARE: MIGHTY MOUTH P.L.L.C.

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	124Q00000X	Dental Hygienist	1140	MT

General Provider Information

NPI Number	:	1205388170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGHTY MOUTH P.L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 267
Second Line	:	34 PLEASANT VIEW LANE
City	:	BELT
State	:	MT
Zip	:	59412
Country	:	US
Telephone Number	:	406-925-2856
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 PLEASANT VIEW LANE
Second Line	:
City	:	BELT
State	:	MT
Zip	:	59412
Country	:	US
Telephone Number	:	406-925-2856
Fax Number	:

Authorized Official
Title or Position	:	DENTAL HYGIENIST
Name	:	MS. BRANDY JEANETTE PIPER
Credential	:	R.D.H.
Telephone Number	:	406-925-2856

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	10/26/2016

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Directions to “MIGHTY MOUTH P.L.L.C. ” Practice Location

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