Provider Demographics
NPI:1275210627
Name:BOZEMAN DENTURE CENTER, PLLC
Entity Type:Organization
Organization Name:BOZEMAN DENTURE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:406-671-0496
Mailing Address - Street 1:308 EASTLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3536
Mailing Address - Country:US
Mailing Address - Phone:406-671-0496
Mailing Address - Fax:
Practice Address - Street 1:2149 DURSTON RD STE 32
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2805
Practice Address - Country:US
Practice Address - Phone:406-586-6569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty