MEDICARE: CURTIS P. SKILLESTAD DDS, P.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	1223G0001X	General Practice Dentistry	1968	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5511350	OTHER	MT	CHIPS
3	72912545	OTHER		TPIN

General Provider Information

NPI Number	:	1629286042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CURTIS P. SKILLESTAD DDS, P.C.

Provider Business Mailing Address
First Line	:	3700 S RUSSELL ST
Second Line	:	SUITE 119
City	:	MISSOULA
State	:	MT
Zip	:	59801-8574
Country	:	US
Telephone Number	:	406-543-2998
Fax Number	:	406-541-2992

Provider Business Practice Location Address
First Line	:	3700 S RUSSELL ST
Second Line	:	SUITE 119
City	:	MISSOULA
State	:	MT
Zip	:	59801-8574
Country	:	US
Telephone Number	:	406-543-2998
Fax Number	:	406-541-2992

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CURTIS PATRICK SKILLESTAD
Credential	:
Telephone Number	:	406-543-2998

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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