# COBURN DENTAL OFFICE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sandcreek Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770831539
- **Authorized official:** DR. RICHARD RYAN COBURN D.M.D (OWNER)
- **Authorized official phone:** (406) 377-8265

## Contact information

- **Practice address:** 116 N MEADE AVE, GLENDIVE, MT 59330-1604
- **Practice address phone:** (406) 377-8265
- **Practice address fax:** (406) 377-8267
- **Mailing address:** 116 N MEADE AVE, GLENDIVE, MT 59330-1604
- **Mailing address phone:** (406) 377-8265
- **Mailing address fax:** (406) 377-8267

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 2288 | MT | Yes |

## Other

- **Enumeration date:** 08/27/2012
- **Last updated:** 11/23/2015