| Mountain Shore Pllc | |
|
50113 Us Highway 93 Polson MT 59860-7035 | |
| (406) 883-4700 | |
| Not Available |
| Full Name | Mountain Shore Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 50113 Us Highway 93, Polson, Montana |
| Authorized Official Name and Position | Joshua Ricks (DENTIST/OWNER) |
| Authorized Official Contact | 4068834700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Shore Pllc 50113 Us Highway 93 Polson MT 59860-7035 Ph: (406) 883-4700 | Mountain Shore Pllc 50113 Us Highway 93 Polson MT 59860-7035 Ph: (406) 883-4700 |
| NPI Number | 1558909093 |
|---|---|
| Provider Enumeration Date | 12/16/2019 |
| Last Update Date | 12/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558909093 | NPI | - | NPPES |
| 0647377 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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