State of Montana

NPI #1912120817 in Helena, Montana

Provider Information

NPI Number: 1912120817
Entity Type: Organization
Organization Name: State of Montana
Subpart: Yes (part of a larger organization)
Parent Organization: STATE OF MONTANA
Primary Specialty: Clinic/Center - Oral and Maxillofacial Surgery
Enumeration Date: Apr 10, 2007
Last Updated: Jan 25, 2011

Practice Location

Address: 1400 BROADWAY RM A116
City: Helena
State: Montana
ZIP Code: 59620
Phone: (406) 444-3529

Authorized Official

Name: MICHELE S O'DONNELL
Title: BILLING AGENT
Phone: (406) 444-3529

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	261QS0112X	Primary

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