Provider Demographics
NPI:1790939932
Name:CHILDREN'S DENTISTRY OF THE ROCKIES
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF THE ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-549-2395
Mailing Address - Street 1:1009 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3140
Mailing Address - Country:US
Mailing Address - Phone:406-549-2395
Mailing Address - Fax:406-549-2437
Practice Address - Street 1:1009 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3140
Practice Address - Country:US
Practice Address - Phone:406-549-2395
Practice Address - Fax:406-549-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty