# MISA04, LLC

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

## Provider details

- **NPI number:** 1588366611
- **Authorized official:** DR. WILLIAM WINTERHOLLER DDS (OWNER)
- **Authorized official phone:** (406) 697-5756

## Contact information

- **Practice address:** 3020 S RESERVE ST, MISSOULA, MT 59801-7652
- **Practice address phone:** (406) 697-5756
- **Mailing address:** 683 HENRY CHAPPLE ST, BILLINGS, MT 59106-1839

## Taxonomy

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

## Other

- **Enumeration date:** 03/21/2023
- **Last updated:** 03/21/2023