MEDICARE: MT SPECIALTY DENTAL SERVICES, PLLC

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1558101378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT SPECIALTY DENTAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1610 54TH AVE N STE 205
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-1442
Country	:	US
Telephone Number	:	615-678-0759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 GRAND AVE STE B
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-2682
Country	:	US
Telephone Number	:	406-652-5550
Fax Number	:

Authorized Official
Title or Position	:	DIREC OF CRED AND PR
Name	:	CHARLOTTE DASCH
Credential	:
Telephone Number	:	504-638-0303

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	01/26/2026

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