Provider Demographics
NPI:1841573243
Name:SOUTH HILLS DENTAL
Entity Type:Organization
Organization Name:SOUTH HILLS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-443-2780
Mailing Address - Street 1:2480 TRACY DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4907
Mailing Address - Country:US
Mailing Address - Phone:406-443-2780
Mailing Address - Fax:406-443-5902
Practice Address - Street 1:2480 TRACY DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4907
Practice Address - Country:US
Practice Address - Phone:406-443-2780
Practice Address - Fax:406-443-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2207MT122300000X
MT1545MT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty