Organization
SAPPHIRE DENTAL GROUP, PC
Active
Other names
Family Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN D. MODULA (GENERAL MANAGER)
(406) 541-2889
Entity
Organization
Contact information
Practice address
FAMILY DENTAL GROUP, 2901 BROOKS ST., MISSOULA, MT 59801-7722
(406) 541-2886
(406) 541-2889
Mailing address
FAMILY DENTAL GROUP, 2901 BROOKS ST., MISSOULA, MT 59801-7722
(406) 541-2886
(406) 541-2889
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2016
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000020164
BLUE CROSS BLUE SHIELD
MT
05
—
5510771
—
MT
Enumeration date
05/31/2005
Last updated
08/22/2020
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