Provider Demographics
NPI:1376941096
Name:BC RESTORATIONS INC
Entity Type:Organization
Organization Name:BC RESTORATIONS INC
Other - Org Name:RESTORATIONS DENTURE STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTURES
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:BRISENDINE
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:406-752-3733
Mailing Address - Street 1:308 MORNING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8167
Mailing Address - Country:US
Mailing Address - Phone:406-752-3733
Mailing Address - Fax:406-752-3734
Practice Address - Street 1:6 SUNSET PLZ STE C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3659
Practice Address - Country:US
Practice Address - Phone:406-752-3733
Practice Address - Fax:406-752-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4206122400000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty