Individual
DR. TERRY KLISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2603 DEER CANYON CT, MISSOULA, MT 59808-8638
(406) 529-2612
(406) 721-1126
Mailing address
2603 DEER CANYON CT, MISSOULA, MT 59808-8638
(406) 529-2612
(406) 721-1126
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
2229
MT
1223G0001X
General Practice Dentistry
2229
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200317590
—
IN
Enumeration date
07/27/2006
Last updated
07/28/2016
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