MEDICARE: MOLARS ON THE MOVE 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	124Q00000X	Dental Hygienist	1060	MT
2	261QD0000X	Dental Clinic/Center	1060	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

General Provider Information

NPI Number	:	1801384037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOLARS ON THE MOVE PLLC

Provider Business Mailing Address
First Line	:	2812 6TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-3127
Country	:	US
Telephone Number	:	406-799-3876
Fax Number	:

Provider Business Practice Location Address
First Line	:	2812 6TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-3127
Country	:	US
Telephone Number	:	406-799-3876
Fax Number	:

Authorized Official
Title or Position	:	DENTAL HYGIENE
Name	:	MRS. KIM R DUNLAP
Credential	:	RDH
Telephone Number	:	406-799-3876

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	04/24/2018

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Directions to “MOLARS ON THE MOVE PLLC ” Practice Location

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