Provider Demographics
NPI:1619413184
Name:SMILE MONTANA URGENT DENTAL CENTER
Entity Type:Organization
Organization Name:SMILE MONTANA URGENT DENTAL CENTER
Other - Org Name:COLUMBIA FALLS FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-892-2104
Mailing Address - Street 1:115 COMMONS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1906
Mailing Address - Country:US
Mailing Address - Phone:406-892-2104
Mailing Address - Fax:406-892-1422
Practice Address - Street 1:115 COMMONS WAY STE 102
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1906
Practice Address - Country:US
Practice Address - Phone:406-892-2104
Practice Address - Fax:406-892-1422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA FALLS FAMILY DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24631223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT=========Medicaid