Provider Demographics
NPI:1073646543
Name:TWIN CRANES DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:TWIN CRANES DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GENDROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-9442
Mailing Address - Street 1:1227 S HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-4140
Mailing Address - Country:US
Mailing Address - Phone:406-728-9442
Mailing Address - Fax:
Practice Address - Street 1:1227 S HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4140
Practice Address - Country:US
Practice Address - Phone:406-728-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT=========Medicaid