Provider Demographics
NPI:1710133418
Name:MONTANA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MONTANA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:WELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-538-2347
Mailing Address - Street 1:611 NE MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2020
Mailing Address - Country:US
Mailing Address - Phone:406-538-2347
Mailing Address - Fax:
Practice Address - Street 1:611 NE MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2020
Practice Address - Country:US
Practice Address - Phone:406-538-2347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2286122300000X
MT2327122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty