Organization
ROUNDUP FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK DAIGREPONT DDS (GENERAL DENTIST)
(406) 323-1234
Entity
Organization
Contact information
Practice address
239 MAIN ST, ROUNDUP, MT 59072-2735
(406) 323-1234
Mailing address
239 MAIN ST, ROUNDUP, MT 59072-2735
(406) 323-1234
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146801068
—
MT
Enumeration date
05/07/2022
Last updated
05/13/2022
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