Organization
KALISPELL ORAL SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA BLANTON-DICKENS DMD (MEMBER)
(406) 755-6014
Entity
Organization
Contact information
Practice address
180 TIMBERWOLF PKWY, KALISPELL, MT 59901-1218
(406) 755-6014
(406) 755-6094
Mailing address
180 TIMBERWOLF PKWY, KALISPELL, MT 59901-1218
(406) 755-6014
(406) 755-6094
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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