Provider Demographics
NPI:1407424179
Name:MT WEST DENTIST PLLC
Entity Type:Organization
Organization Name:MT WEST DENTIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-708-1685
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0837
Mailing Address - Country:US
Mailing Address - Phone:406-215-4705
Mailing Address - Fax:406-258-0612
Practice Address - Street 1:200 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-7763
Practice Address - Country:US
Practice Address - Phone:406-215-4705
Practice Address - Fax:406-258-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty