Provider Demographics
NPI:1477724359
Name:DALE & JAX DOOR & GLASS, INC.
Entity Type:Organization
Organization Name:DALE & JAX DOOR & GLASS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SAMSAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-252-8990
Mailing Address - Street 1:PO BOX 80385
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59108-0385
Mailing Address - Country:US
Mailing Address - Phone:406-252-8990
Mailing Address - Fax:406-252-0051
Practice Address - Street 1:536 MOORE LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4623
Practice Address - Country:US
Practice Address - Phone:406-252-8990
Practice Address - Fax:406-252-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10059171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty