# KALISPELL REGIONAL MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Glacier Oral and Maxillofacial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407301872
- **Authorized official:** PAMELA S ROBERTSON (PRESIDENT/CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (406) 752-1724

## Contact information

- **Practice address:** 711 E 13TH ST, SUITE 101, WHITEFISH, MT 59937-2964
- **Practice address phone:** (406) 862-5656
- **Practice address fax:** (406) 862-6155
- **Mailing address:** 711 E 13TH ST, SUITE 101, WHITEFISH, MT 59937-2964
- **Mailing address phone:** (406) 862-5656
- **Mailing address fax:** (406) 862-6155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | 11198 | MT | Yes |

## Other

- **Enumeration date:** 08/16/2016
- **Last updated:** 10/04/2017