Provider Demographics
NPI:1629286042
Name:CURTIS P. SKILLESTAD DDS, P.C.
Entity Type:Organization
Organization Name:CURTIS P. SKILLESTAD DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SKILLESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-543-2998
Mailing Address - Street 1:3700 S RUSSELL ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8574
Mailing Address - Country:US
Mailing Address - Phone:406-543-2998
Mailing Address - Fax:406-541-2992
Practice Address - Street 1:3700 S RUSSELL ST
Practice Address - Street 2:SUITE 119
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8574
Practice Address - Country:US
Practice Address - Phone:406-543-2998
Practice Address - Fax:406-541-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0112112Medicaid
MT5511350OtherCHIPS
72912545OtherTPIN