Organization
MOUNTAIN SHORE PLLC
Active
Other names
Bayview Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA RICKS DDS (DENTIST/OWNER)
(406) 883-4700
Entity
Organization
Contact information
Practice address
50113 US HIGHWAY 93, POLSON, MT 59860-7035
(406) 883-4700
Mailing address
50113 US HIGHWAY 93, POLSON, MT 59860-7035
(406) 883-4700
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0647377
—
MT
Enumeration date
12/16/2019
Last updated
12/16/2019
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