Provider Demographics
NPI:1205388170
Name:MIGHTY MOUTH P.L.L.C.
Entity Type:Organization
Organization Name:MIGHTY MOUTH P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:406-925-2856
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:34 PLEASANT VIEW LANE
Mailing Address - City:BELT
Mailing Address - State:MT
Mailing Address - Zip Code:59412
Mailing Address - Country:US
Mailing Address - Phone:406-925-2856
Mailing Address - Fax:
Practice Address - Street 1:34 PLEASANT VIEW LANE
Practice Address - Street 2:
Practice Address - City:BELT
Practice Address - State:MT
Practice Address - Zip Code:59412
Practice Address - Country:US
Practice Address - Phone:406-925-2856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1140124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty