Organization
MISSOULA PEDITRIC DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL LEONARD TIEDE (BUSINESS MANAGER)
(406) 541-7334
Entity
Organization
Contact information
Practice address
3020 S RESERVE ST STE D, MISSOULA, MT 59801-7652
(406) 541-7334
(406) 541-7338
Mailing address
3020 S RESERVE ST STE D, MISSOULA, MT 59801-7652
(406) 541-7334
(406) 541-7338
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4170
MT
Other
Enumeration date
08/13/2012
Last updated
08/13/2012
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