GLACIER ORAL AND MAXILLOFACIAL SURGERY PC NPI 1043373012

NPI Information

NPI: 1043373012
Provider Name: GLACIER ORAL AND MAXILLOFACIAL SURGERY PC
Classification: Clinic/Center - 261QS0112X
Specialization: Oral and Maxillofacial Surgery
Entity Type: Organization
Address: 711 13TH STR E
STE 101
WHITEFISH, MT
ZIP 59937
Phone: (406) 862-5656

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NPI Details

GLACIER ORAL AND MAXILLOFACIAL SURGERY PC is an oral and maxillofacial surgery clinic center in Whitefish, MT. The provider is an oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. GLACIER ORAL AND MAXILLOFACIAL SURGERY PC NPI is 1043373012. The provider is registered as an organization entity type.

The provider's business location address is:

711 13TH STR E
STE 101
WHITEFISH, MT
ZIP 59937
Phone: (406) 862-5656
Fax: (406) 862-6155

The provider's authorized official is Bernadette L Wilson .
The authorized official title is President and has the following contact phone number (406) 862-5656.

The enumeration date for this NPI number is 12/19/2006 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QS0112X	Clinic/Center	Oral and Maxillofacial Surgery	11198	MONTANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0130186	MEDICAID	MONTANA
2	95296	OTHER	MONTANA	BLUE CROSS BLUE SHIELD ID
3	2235	OTHER	MONTANA	MONTANA DENTAL LICENSE #
4	11198	OTHER	MONTANA	MONTANA MEDICAL LICENSE #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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