Organization
MT SDS III, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE E VIAL (DIREC OF CRED AND PROV REL)
(504) 638-0303
Entity
Organization
Contact information
Practice address
1256 N MERIDIAN RD STE A, KALISPELL, MT 59901-3006
(406) 752-1131
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
01/24/2024
Last updated
01/24/2024
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