Provider Demographics
NPI:1437573003
Name:CASCADE FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:CASCADE FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-315-8004
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:SUN RIVER
Mailing Address - State:MT
Mailing Address - Zip Code:59483-0036
Mailing Address - Country:US
Mailing Address - Phone:406-315-8004
Mailing Address - Fax:406-315-8003
Practice Address - Street 1:2507 6TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3013
Practice Address - Country:US
Practice Address - Phone:406-315-8004
Practice Address - Fax:406-315-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT60791223G0001X
126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty