Provider Demographics
NPI:1639522592
Name:GREAT SMILES
Entity Type:Organization
Organization Name:GREAT SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:POLLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:406-799-3342
Mailing Address - Street 1:1049 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TOSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59643-9755
Mailing Address - Country:US
Mailing Address - Phone:406-799-3342
Mailing Address - Fax:
Practice Address - Street 1:1049 RIVER RD
Practice Address - Street 2:
Practice Address - City:TOSTON
Practice Address - State:MT
Practice Address - Zip Code:59643-9755
Practice Address - Country:US
Practice Address - Phone:406-799-3342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1320124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty