Provider Demographics
NPI:1629324306
Name:RIMROCK PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:RIMROCK PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-248-3303
Mailing Address - Street 1:1601 ZIMMERMAN TRAIL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7652
Mailing Address - Country:US
Mailing Address - Phone:406-248-3303
Mailing Address - Fax:406-248-3939
Practice Address - Street 1:1601 ZIMMERMAN TRAIL
Practice Address - Street 2:SUITE 1
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7652
Practice Address - Country:US
Practice Address - Phone:406-248-3303
Practice Address - Fax:406-248-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty