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Organization
NANETTE B.I. AULT, D.D.S., P.C.
Active
Organization
NANETTE B.I. AULT, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANETTE B.I. AULT D.D.S., P.C. (PERIODONTIST)
(406) 549-4867
Entity
Organization
Contact information
Practice address
619 SW HIGGINS AVE STE G, MISSOULA, MT 59803-1430
(406) 549-4867
(406) 721-3692
Mailing address
P.O. BOX 1131, MISSOULA, MT 59806
(406) 549-4867
(406) 721-3692
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2089
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113390
—
MT
01
—
2089
DELTA
MT
01
—
20894
BLUECROSS BLUESHIELD
MT
Enumeration date
11/16/2006
Last updated
08/22/2020
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