Individual
MR. GAYLE R. SIEMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
#2 6TH AVE EAST, POLSON, MT 59860
(406) 883-6269
(406) 883-9203
Mailing address
#2 6TH AVE E., POLSON, MT 59860
(406) 883-6269
(406) 883-9203
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11-1618
—
MT
01
—
16174
BLUE CROS BLUE SHIELD MT
MT
Enumeration date
01/09/2007
Last updated
07/09/2007
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