Provider Demographics
NPI:1023401312
Name:MOUNTAIN PEAK DENTAL
Entity Type:Organization
Organization Name:MOUNTAIN PEAK DENTAL
Other - Org Name:DR. JEFFREY K. DAVIDSON, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-363-4010
Mailing Address - Street 1:421 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2760
Mailing Address - Country:US
Mailing Address - Phone:406-363-4010
Mailing Address - Fax:406-375-0589
Practice Address - Street 1:421 STATE ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2760
Practice Address - Country:US
Practice Address - Phone:406-363-4010
Practice Address - Fax:406-375-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT79131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty