GREAT FALLS PEDIATRIC DENTISTRY LLC NPI 1922479047

NPI Information

GREAT FALLS PEDIATRIC DENTISTRY, LLC is a pediatric dentistry dentist in Great Falls, MT. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. GREAT FALLS PEDIATRIC DENTISTRY, LLC NPI is 1922479047. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1717 4TH ST S
GREAT FALLS, MT
ZIP 59405-133
Phone: (406) 449-0189
Fax: (406) 449-7237

The provider's authorized official is Kevin L Rencher .
The authorized official title is Dentist and has the following contact phone number (406) 449-0189.

The CLIA number assigned to this NPI record is 27D2074277 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/15/2015 and was last updated on 10/15/2015.

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:

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