Provider Demographics
NPI:1689342503
Name:MONTANA ORAL SURGERY, PLLC
Entity Type:Organization
Organization Name:MONTANA ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:SCHULZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-443-3334
Mailing Address - Street 1:65 MEDICAL PARK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8048
Mailing Address - Country:US
Mailing Address - Phone:406-443-3334
Mailing Address - Fax:406-443-3335
Practice Address - Street 1:65 MEDICAL PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8048
Practice Address - Country:US
Practice Address - Phone:406-443-3334
Practice Address - Fax:406-443-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty