# BOULDER VALLEY DENTAL LLC

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

## Provider details

- **NPI number:** 1548864358
- **Authorized official:** LISA HUEMPFNER DMD (OWNER/DENTIST)
- **Authorized official phone:** (262) 497-5559

## Contact information

- **Practice address:** 211 N MAIN ST, BOULDER, MT 59632-7761
- **Practice address phone:** (406) 225-4222
- **Mailing address:** PO BOX 512, BOULDER, MT 59632-0512

## Taxonomy

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

## Other

- **Enumeration date:** 11/23/2020
- **Last updated:** 11/23/2020