Provider Demographics
NPI:1083475701
Name:HAVRE DENTURE LLC
Entity Type:Organization
Organization Name:HAVRE DENTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FABIONE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, LAT
Authorized Official - Phone:406-262-7722
Mailing Address - Street 1:220 3RD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3554
Mailing Address - Country:US
Mailing Address - Phone:406-262-7722
Mailing Address - Fax:406-262-7723
Practice Address - Street 1:220 3RD AVE STE 204
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3554
Practice Address - Country:US
Practice Address - Phone:406-262-7722
Practice Address - Fax:406-262-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist