Organization
MISSOULA ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRANT MATTHEW WISWELL M.D,, D.D.S (OWNER/SURGEON)
(406) 552-9970
Entity
Organization
Contact information
Practice address
3020 S RESERVE ST, SUITE C, MISSOULA, MT 59801-7644
(406) 552-9970
Mailing address
3020 S RESERVE ST, SUITE C, MISSOULA, MT 59801-7644
(406) 552-9970
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
2433
MT
Other
Enumeration date
04/04/2011
Last updated
04/04/2011
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