Provider Demographics
NPI:1447805304
Name:MIHAILOVICH FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:MIHAILOVICH FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIHAILOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-494-7033
Mailing Address - Street 1:2423 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3848
Mailing Address - Country:US
Mailing Address - Phone:406-494-7033
Mailing Address - Fax:406-494-8256
Practice Address - Street 1:2423 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3848
Practice Address - Country:US
Practice Address - Phone:406-494-7033
Practice Address - Fax:406-494-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5965OtherMONTANA DENTAL LICENSE NUMBER