Organization
SPROUT ORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE GILLETTE (PRESIDENT)
(406) 868-1549
Entity
Organization
Contact information
Practice address
108 VILLAGE DOWNTOWN BLVD, BOZEMAN, MT 59715-3815
(406) 868-1549
Mailing address
PO BOX 1028, BOZEMAN, MT 59771-1028
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7115108
—
MT
Enumeration date
10/17/2013
Last updated
03/27/2014
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