MEDICARE: BILLINGS WEST GENERAL DENTISTRY

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	1743	MT

General Provider Information

NPI Number	:	1962739649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILLINGS WEST GENERAL DENTISTRY

Provider Business Mailing Address
First Line	:	2700 GRAND AVE STE F
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-2682
Country	:	US
Telephone Number	:	406-245-9556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 GRAND AVE STE F
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-2682
Country	:	US
Telephone Number	:	406-245-9556
Fax Number	:	406-245-5113

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW CHARLES HYAMS
Credential	:	DDS
Telephone Number	:	406-245-9556

Provider Enumeration Date	:	11/17/2009
Last Update Date	:	11/17/2009

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