MEDICARE: DR. ANDREW C ALTHAUSER DDS

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	2152	MT

General Provider Information

NPI Number	:	1245278647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW C ALTHAUSER DDS

Provider Business Mailing Address
First Line	:	237 SW HIGGINS AVE STE C
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1485
Country	:	US
Telephone Number	:	406-721-2830
Fax Number	:	406-549-5053

Provider Business Practice Location Address
First Line	:	237 SW HIGGINS AVE STE C
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1485
Country	:	US
Telephone Number	:	406-721-2830
Fax Number	:	406-549-5053

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/04/2025

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