Provider Demographics
NPI:1639622707
Name:PILATI, JAMIE PURCELL (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:PURCELL
Last Name:PILATI
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:PURCELL
Other - Last Name:PILATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:5480 SOURDOUGH RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8018
Mailing Address - Country:US
Mailing Address - Phone:406-570-3946
Mailing Address - Fax:
Practice Address - Street 1:5480 SOURDOUGH RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8018
Practice Address - Country:US
Practice Address - Phone:406-570-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT529124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist