Organization
NANETTE B.I. AULT, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANETTE B.I. AULT D.D.S., P.C. (PERIODONTIST)
(406) 549-4867
Entity
Organization
Contact information
Practice address
619 SW HIGGINS AVE STE G, MISSOULA, MT 59803-1430
(406) 549-4867
(406) 721-3692
Mailing address
P.O. BOX 1131, MISSOULA, MT 59806
(406) 549-4867
(406) 721-3692
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2089
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0113390
—
MT
01
—
2089
DELTA
MT
01
—
20894
BLUECROSS BLUESHIELD
MT
Enumeration date
11/16/2006
Last updated
08/22/2020
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