Provider Demographics
NPI:1164870390
Name:ARROWHEAD DENTAL PC
Entity Type:Organization
Organization Name:ARROWHEAD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-557-6453
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59337-0034
Mailing Address - Country:US
Mailing Address - Phone:406-557-6453
Mailing Address - Fax:
Practice Address - Street 1:433 MAIN STREET
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MT
Practice Address - Zip Code:59337
Practice Address - Country:US
Practice Address - Phone:406-557-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty