Provider Demographics
NPI:1407418312
Name:BOZEMAN ORAL SURGERY AND IMPLANT CENTER
Entity Type:Organization
Organization Name:BOZEMAN ORAL SURGERY AND IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAROM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-551-2816
Mailing Address - Street 1:4535 VALLEY COMMONS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4161
Mailing Address - Country:US
Mailing Address - Phone:406-551-2816
Mailing Address - Fax:
Practice Address - Street 1:4535 VALLEY COMMONS DR STE 102
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4161
Practice Address - Country:US
Practice Address - Phone:406-551-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty