Organization
BIGFORK DENTAL CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY MCCRUMMEN D.D.S. (PRESIDENT)
(406) 837-5611
Entity
Organization
Contact information
Practice address
8289 MT HIGHWAY 35, BIGFORK, MT 59911-3518
(406) 837-5611
Mailing address
8289 MT HIGHWAY 35, BIGFORK, MT 59911-3518
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1636
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5512692
MT CHIPS PROGRAM
MT
Enumeration date
08/13/2007
Last updated
08/13/2007
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