Provider Demographics
NPI:1477627032
Name:DEIBERT, LANI COOK (DMD)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:COOK
Last Name:DEIBERT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:COOK
Other - Last Name:MCLANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:289 DEREK WAY
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7304
Mailing Address - Country:US
Mailing Address - Phone:406-570-6913
Mailing Address - Fax:
Practice Address - Street 1:120 N 19TH AVE STE H
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3920
Practice Address - Country:US
Practice Address - Phone:406-585-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-40321223G0001X
MT22711223G0001X
MT#2271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice