Missoula Pediatric Dentistry Pc

LBN: Missoula Pediatric Dentistry Pc
Missoula Pediatric Dentistry Pc is an health care organization with primary practice located at 1300 South Reserve St Suite B, Missoula MT 59801. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is the primary health care specialty. Missoula Pediatric Dentistry Pc can be contacted via phone (406) 541-7334, or through Tiede, Paul Leonard via phone (406) 541-7334.

Contact Information

Primary practice address
1300 South Reserve St Suite B Missoula MT 59801
Fax: (406) 541-7338
Website:
Authorized official contact:
Name: Tiede, Paul Leonard

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X MT2229 Montana
Dental Providers / General Practice 1223G0001X MT2212 Montana
Dental Providers / Pediatric Dentistry 1223P0221X MT2151 Montana

Profile Details

NPI number 1942483524
LBN Legal business name Missoula Pediatric Dentistry Pc
DBA Doing business as
Authorized official Tiede, Paul Leonard
Entity Organization
Organization subpart 1 No
Enumeration date Dec 6th, 2007
Last updated Jan 31st, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942483524 NPPES
Montana MEDICAID 1558308221
Montana Other 5512641

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