Provider Demographics
NPI:1699849091
Name:AMELINE, AIMEE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:R
Last Name:AMELINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 16 AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-761-4288
Mailing Address - Fax:406-761-7688
Practice Address - Street 1:2609 16 AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-761-4288
Practice Address - Fax:406-761-7688
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2048MT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0113577Medicaid
1376945OtherTRICARE UNITED CONCORDIA
MT41344OtherBLUE CROSS BLUE SHIELD