MEDICARE: CORE DENTAL CARE

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	12795	MT

General Provider Information

NPI Number	:	1518495845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE DENTAL CARE

Provider Business Mailing Address
First Line	:	1724 LONE PINE DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-8973
Country	:	US
Telephone Number	:	507-316-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 GRAND AVE STE C
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-2682
Country	:	US
Telephone Number	:	406-652-9100
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHALSEY NELSEN
Credential	:	DDS
Telephone Number	:	406-652-9100

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	05/31/2017

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