Provider Demographics
NPI:1952076820
Name:MISSOULA DENTAL, PC
Entity Type:Organization
Organization Name:MISSOULA DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:SAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-579-5998
Mailing Address - Street 1:103 W JEFFERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-4419
Mailing Address - Country:US
Mailing Address - Phone:406-388-3005
Mailing Address - Fax:406-388-4265
Practice Address - Street 1:690 SW HIGGINS AVE STE H
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1433
Practice Address - Country:US
Practice Address - Phone:406-543-3149
Practice Address - Fax:406-543-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty