Provider Demographics
NPI:1740799527
Name:GLACIER GRINS PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:GLACIER GRINS PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CATTRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-916-9575
Mailing Address - Street 1:155 HUTTON RANCH RD # 102
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2133
Mailing Address - Country:US
Mailing Address - Phone:425-951-9576
Mailing Address - Fax:
Practice Address - Street 1:155 HUTTON RANCH RD # 102
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2133
Practice Address - Country:US
Practice Address - Phone:425-951-9576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental