# SPROUT ORAL HEALTH

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

## Provider details

- **NPI number:** 1700214350
- **Authorized official:** JANE GILLETTE (PRESIDENT)
- **Authorized official phone:** (406) 868-1549

## Contact information

- **Practice address:** 108 VILLAGE DOWNTOWN BLVD, BOZEMAN, MT 59715-3815
- **Practice address phone:** (406) 868-1549
- **Mailing address:** PO BOX 1028, BOZEMAN, MT 59771-1028

## Taxonomy

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

## Other

- **Enumeration date:** 10/17/2013
- **Last updated:** 03/27/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7115108 | — | MT |