Provider Demographics
NPI:1780229195
Name:RAB DENTAL LLC
Entity Type:Organization
Organization Name:RAB DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BRONECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-633-4910
Mailing Address - Street 1:306 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-3049
Mailing Address - Country:US
Mailing Address - Phone:406-633-4910
Mailing Address - Fax:
Practice Address - Street 1:306 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3049
Practice Address - Country:US
Practice Address - Phone:406-633-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty