Provider Demographics
NPI:1629297635
Name:REMIEN, JOHN C II (DDS,MS,FACD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:REMIEN
Suffix:II
Gender:M
Credentials:DDS,MS,FACD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 STEPHENS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8505
Mailing Address - Country:US
Mailing Address - Phone:406-728-8910
Mailing Address - Fax:406-728-1625
Practice Address - Street 1:3817 STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8505
Practice Address - Country:US
Practice Address - Phone:406-728-8910
Practice Address - Fax:406-728-1625
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics