MEDICARE: DR. DIRK FRED ROOSMA 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	2073	MT

General Provider Information

NPI Number	:	1629146634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIRK FRED ROOSMA D.M.D

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:
City	:	HOT SPRINGS
State	:	MT
Zip	:	59845-0127
Country	:	US
Telephone Number	:	406-741-5031
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 LITTLE BITTERROOT RD
Second Line	:
City	:	HOT SPRINGS
State	:	MT
Zip	:	59845
Country	:	US
Telephone Number	:	406-741-5031
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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