| Missoula Pediatric Dentistry Pc | |
|
1300 South Reserve St Suite B Missoula MT 59801 | |
| (406) 541-7334 | |
| (406) 541-7338 |
| Full Name | Missoula Pediatric Dentistry Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1300 South Reserve St, Missoula, Montana |
| Authorized Official Name and Position | Paul Leonard Tiede (BUSINESS MANAGER) |
| Authorized Official Contact | 4065417334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Missoula Pediatric Dentistry Pc 1300 South Reserve St Suite B Missoula MT 59801 Ph: (406) 541-7334 | Missoula Pediatric Dentistry Pc 1300 South Reserve St Suite B Missoula MT 59801 Ph: (406) 541-7334 |
| NPI Number | 1942483524 |
|---|---|
| Provider Enumeration Date | 12/06/2007 |
| Last Update Date | 01/31/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942483524 | NPI | - | NPPES |
| 1558308221 | Medicaid | MT | |
| 5512641 | Other | MT | CHIPS |
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