# MONTANA DENTAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144767203
- **Authorized official:** BRADY SEFCIK (OFFICIAL)
- **Authorized official phone:** (801) 400-4560

## Contact information

- **Practice address:** 203 MAIN ST, POLSON, MT 59860-2119
- **Practice address phone:** (406) 883-0325
- **Mailing address:** 203 MAIN STREET, POLSON, MT 59860
- **Mailing address phone:** (406) 883-0325

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 00202298 | CO | Yes |

## Other

- **Enumeration date:** 01/27/2017
- **Last updated:** 01/27/2017