Provider Demographics
NPI:1972833846
Name:FRED L. SAYRE DMD PC
Entity Type:Organization
Organization Name:FRED L. SAYRE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-728-4032
Mailing Address - Street 1:705 W SUSSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6834
Mailing Address - Country:US
Mailing Address - Phone:406-728-4032
Mailing Address - Fax:406-728-7380
Practice Address - Street 1:705 W SUSSEX AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6834
Practice Address - Country:US
Practice Address - Phone:406-728-4032
Practice Address - Fax:406-728-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13081223X0400X
MT21381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty