Provider Demographics
NPI:1821328394
Name:MONTANA ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Entity Type:Organization
Organization Name:MONTANA ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:406-443-3334
Mailing Address - Street 1:65 MEDICAL PARK DR
Mailing Address - Street 2:UNIT #1
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8048
Mailing Address - Country:US
Mailing Address - Phone:406-443-3334
Mailing Address - Fax:
Practice Address - Street 1:65 MEDICAL PARK DR
Practice Address - Street 2:UNIT #1
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8048
Practice Address - Country:US
Practice Address - Phone:406-443-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT134633Medicaid
MT134633OtherPERSONAL NPI NUMBER