Misa04, LLC

NPI #1588366611 in Missoula, Montana

Provider Information

NPI Number: 1588366611
Entity Type: Organization
Organization Name: Misa04, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 21, 2023
Last Updated: Mar 21, 2023

Practice Location

Address: 3020 S RESERVE ST
City: Missoula
State: Montana
ZIP Code: 59801-7652
Phone: (406) 697-5756

Authorized Official

Name: DR. WILLIAM WINTERHOLLER, DDS
Title: OWNER
Phone: (406) 697-5756

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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