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GLACIER ORAL AND MAXILLOFACIAL SURGERY PC

Surgery Yellow Pages

Whitefish, Montana

Provider NPI: 1043373012

Organization Information:
Organization Name:  GLACIER ORAL AND MAXILLOFACIAL SURGERY PC


Practice Location:
711 13TH STR E STE 101 WHITEFISH, MT 59937 US
Tel: 406-862-5656  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QS0112XAmbulatory Health Care Facilities
Clinic/Center
Oral and Maxillofacial Surgery
MT11198

Other Provider Identifiers:

IssuerNumberStateType
MONTANA DENTAL LICENSE #2235MT01
DEA NUMBERBW6535617MT01
MONTANA MEDICAL LICENSE #11198MT01
BLUE CROSS BLUE SHIELD ID95296MT01
0130186MT05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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