# BRUK P. WEYMOUTH, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053462341
- **Authorized official:** PENNY WEYMOUTH (OFFICE MANAGER)
- **Authorized official phone:** (406) 727-1006

## Contact information

- **Practice address:** 3224 10TH AVE S, GREAT FALLS, MT 59405-3449
- **Practice address phone:** (406) 727-1006
- **Practice address fax:** (406) 727-1008
- **Mailing address:** PO BOX 7050, GREAT FALLS, MT 59406-7050
- **Mailing address phone:** (406) 727-1006
- **Mailing address fax:** (406) 727-1008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1786 | MT | — |
| 1223G0001X | General Practice Dentistry | 2091 | MT | Yes |

## Other

- **Enumeration date:** 01/15/2007
- **Last updated:** 04/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0112659 | — | MT |
| 05 | — | 0112829 | — | MT |
| 01 | — | 5512284 | DR BOLLWITT CHIP ID\# | MT |
| 01 | — | 5512386 | DR WEYMOUTH CHIP ID \# | MT |