Provider Demographics
NPI:1285008847
Name:SILVERCREEK FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:SILVERCREEK FAMILY DENTISTRY PLLC
Other - Org Name:SILVERCREEK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GUNDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-494-7058
Mailing Address - Street 1:245 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1829
Mailing Address - Country:US
Mailing Address - Phone:406-494-7058
Mailing Address - Fax:
Practice Address - Street 1:245 E PARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1829
Practice Address - Country:US
Practice Address - Phone:406-494-7058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT78061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty