Provider Demographics
NPI:1578081428
Name:3 RIVERS PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:3 RIVERS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-393-3773
Mailing Address - Street 1:2680 WASHBURN ST.
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7831
Mailing Address - Country:US
Mailing Address - Phone:406-393-3773
Mailing Address - Fax:406-926-2671
Practice Address - Street 1:2680 WASHBURN ST.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7831
Practice Address - Country:US
Practice Address - Phone:406-393-3773
Practice Address - Fax:406-926-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty