Provider Demographics
NPI:1023181260
Name:NANETTE B.I. AULT, D.D.S., P.C.
Entity Type:Organization
Organization Name:NANETTE B.I. AULT, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:BI
Authorized Official - Last Name:AULT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:406-549-4867
Mailing Address - Street 1:P.O. BOX 1131
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806
Mailing Address - Country:US
Mailing Address - Phone:406-549-4867
Mailing Address - Fax:406-721-3692
Practice Address - Street 1:619 SW HIGGINS AVE STE G
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1430
Practice Address - Country:US
Practice Address - Phone:406-549-4867
Practice Address - Fax:406-721-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT20894OtherBLUECROSS BLUESHIELD
MT0113390Medicaid
MT2089OtherDELTA