Provider Demographics
NPI:1326108986
Name:LACEY, DENNIS R (DDS)
Entity Type:Individual
Prefix:MS
First Name:DENNIS
Middle Name:R
Last Name:LACEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 EASTSIDE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6942
Mailing Address - Country:US
Mailing Address - Phone:406-273-6266
Mailing Address - Fax:406-273-2911
Practice Address - Street 1:5872 EASTSIDE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6942
Practice Address - Country:US
Practice Address - Phone:406-273-6266
Practice Address - Fax:406-273-2911
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0114283Medicaid