Provider Demographics
NPI:1255007589
Name:MT OMS SPECIALTY DENTAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MT OMS SPECIALTY DENTAL SERVICES, PLLC
Other - Org Name:BILLINGS ORAL SURGERY & DENTAL IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-638-0303
Mailing Address - Street 1:1610 54TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1401
Mailing Address - Country:US
Mailing Address - Phone:504-638-0303
Mailing Address - Fax:
Practice Address - Street 1:152 S 32ND ST W STE B
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6875
Practice Address - Country:US
Practice Address - Phone:406-245-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty