Provider Demographics
NPI:1861818668
Name:PEDIATRIC DENTISTRY PC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-449-0189
Mailing Address - Street 1:3116 SADDLE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8645
Mailing Address - Country:US
Mailing Address - Phone:406-449-0189
Mailing Address - Fax:406-449-7237
Practice Address - Street 1:3116 SADDLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8645
Practice Address - Country:US
Practice Address - Phone:406-449-0189
Practice Address - Fax:406-449-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty