Organization
SMILE MISSOULA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE M. OLSEN DDS (PRESIDENT)
(406) 721-2830
Entity
Organization
Contact information
Practice address
237 SW HIGGINS AVE, STE C, MISSOULA, MT 59803-1485
(406) 721-2830
Mailing address
300 BEN HOGAN DR, MISSOULA, MT 59803-2419
(406) 721-2830
(406) 549-5053
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1424
MT
1223G0001X
General Practice Dentistry
2474
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1101-62
—
MT
01
—
5511480
CHIP
MT
Enumeration date
12/12/2011
Last updated
02/24/2012
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