Provider Demographics
NPI:1962511154
Name:SUNSET DENTAL CARE PC
Entity Type:Organization
Organization Name:SUNSET DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:SCHUYLER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-278-3609
Mailing Address - Street 1:417 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425
Mailing Address - Country:US
Mailing Address - Phone:406-278-3609
Mailing Address - Fax:406-278-5458
Practice Address - Street 1:417 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425
Practice Address - Country:US
Practice Address - Phone:406-278-3609
Practice Address - Fax:406-278-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1880122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT18804OtherBLX
MT0112438Medicaid
MT5512182OtherCHIPS