# LOLO DENTAL CLINIC PC

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

## Provider details

- **NPI number:** 1629133186
- **Authorized official:** MARIE ROSE HILLBERRY (VICE PRESIDENT LOLODENTAL CLINIC PC)
- **Authorized official phone:** (406) 273-0490

## Contact information

- **Practice address:** 108 TYLER WAY, LOLO, MT 59847
- **Practice address phone:** (406) 273-0490
- **Practice address fax:** (406) 273-7969
- **Mailing address:** PO BOX 725, LOLO, MT 59847
- **Mailing address phone:** (406) 273-0490
- **Mailing address fax:** (406) 273-7969

## Taxonomy

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

## Other

- **Enumeration date:** 12/26/2006
- **Last updated:** 08/22/2020