Organization
JEWEL BASIN DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY BAGNELL (PRESIDENT)
(406) 614-2020
Entity
Organization
Contact information
Practice address
33 DOC KIMBALL, BIG FORK, MT 59911
(406) 614-2020
Mailing address
33 DOC KIMBALL WAY, BIG FORK, MT 59911
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/20/2020
Last updated
08/03/2021
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