# DR. CONNIE SMALL

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

## Provider details

- **NPI number:** 1558507855
- **Authorized official:** DR. CONNIE L. SMALL D.D.S (OWNER)
- **Authorized official phone:** (406) 755-4127

## Contact information

- **Practice address:** 1050 N MERIDIAN RD, KALISPELL, MT 59901-3542
- **Practice address phone:** (406) 755-4127
- **Practice address fax:** (406) 755-4034
- **Mailing address:** 1050 N MERIDIAN RD, KALISPELL, MT 59901-3542
- **Mailing address phone:** (406) 755-4127
- **Mailing address fax:** (406) 755-4034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1758 | MT | Yes |

## Other

- **Enumeration date:** 12/17/2008
- **Last updated:** 12/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1164508123 | — | MT |
| 05 | — | 1457323719 | — | MT |