Provider Demographics
NPI:1962671370
Name:NORTHERN MONTANA ORAL / MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:NORTHERN MONTANA ORAL / MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-727-4322
Mailing Address - Street 1:2714 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5246
Mailing Address - Country:US
Mailing Address - Phone:406-727-4322
Mailing Address - Fax:406-771-1516
Practice Address - Street 1:2714 15TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5246
Practice Address - Country:US
Practice Address - Phone:406-727-4322
Practice Address - Fax:406-771-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1972611101Medicaid
MT5513100OtherCHIPS
MT1104934314Medicaid
MT5513092OtherCHIPS
MT1972611101Medicaid
MT5513100OtherCHIPS