# ELKHORN FAMILY DENTAL, LLC

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

## Provider details

- **NPI number:** 1740546100
- **Authorized official:** DR. CHARISSA FOSTER MARTIN DMD (OWNER)
- **Authorized official phone:** (406) 225-4222

## Contact information

- **Practice address:** 211 NORTH MAIN STREET, BOULDER, MT 59632-0512
- **Practice address phone:** (406) 225-4222
- **Practice address fax:** (406) 225-4222
- **Mailing address:** PO BOX 512, 211 NORTH MAIN STREET, BOULDER, MT 59632-0512
- **Mailing address phone:** (406) 225-4222
- **Mailing address fax:** (406) 225-4222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 2386 | MT | Yes |

## Other

- **Enumeration date:** 04/10/2012
- **Last updated:** 04/10/2012