Provider Demographics
NPI:1417467911
Name:HEALTHY SMILES MOBILE DENTAL HYGIENE INC
Entity Type:Organization
Organization Name:HEALTHY SMILES MOBILE DENTAL HYGIENE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRING
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:406-581-5293
Mailing Address - Street 1:105 GREY WOLF TRL
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7677
Mailing Address - Country:US
Mailing Address - Phone:406-581-5293
Mailing Address - Fax:406-763-4637
Practice Address - Street 1:105 GREY WOLF TRL
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7677
Practice Address - Country:US
Practice Address - Phone:406-581-5293
Practice Address - Fax:406-581-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT-1008124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1972913176Medicaid