Organization
NORTHWEST DENTURE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH SCOTT MACPHERSON LICENSED DENTURIST (OWNER)
(406) 542-0609
Entity
Organization
Contact information
Practice address
2021 S HIGGINS AVE, MISSOULA, MT 59801-6762
(406) 542-0609
(406) 721-7617
Mailing address
2021 S HIGGINS AVE, MISSOULA, MT 59801-6762
(406) 542-0609
(406) 721-7617
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
DTR MT 18
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215088166
NPI TYPE 1
MT
Enumeration date
06/07/2013
Last updated
06/07/2013
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