Individual
DEREK CHARLES METTENBRINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3020 S RESERVE ST STE D, MISSOULA, MT 59801-7652
(406) 541-7337
Mailing address
4256 DIAGON LN, MISSOULA, MT 59808-5306
(308) 380-5938
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7535
NE
1223P0221X
Pediatric Dentistry
DEN-DEN-LIC-19245
MT
Other
Enumeration date
05/31/2019
Last updated
01/07/2022
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