STATE OF MONTANA

NPI # 

Practice Address:

1400 Broadway Rm A116

Helena, MT, 59620

Practice Phone:

406-444-3529

Practice Fax:

406-444-2750

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Oral and Maxillofacial Surgery

Taxonomy Code:

261QS0112X