Provider Demographics
NPI:1710693072
Name:QUEEN CITY DENTAL STUDIO, PLLC
Entity Type:Organization
Organization Name:QUEEN CITY DENTAL STUDIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEMPFNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-449-1300
Mailing Address - Street 1:1300 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3507
Mailing Address - Country:US
Mailing Address - Phone:406-449-1300
Mailing Address - Fax:
Practice Address - Street 1:1300 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3507
Practice Address - Country:US
Practice Address - Phone:406-449-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty