Provider Demographics
NPI:1205978798
Name:VESBACH, DANIEL JEFFERY (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JEFFERY
Last Name:VESBACH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MELODY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-7188
Mailing Address - Country:US
Mailing Address - Phone:406-322-4600
Mailing Address - Fax:406-322-4607
Practice Address - Street 1:340 E. PIKE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019
Practice Address - Country:US
Practice Address - Phone:406-322-4600
Practice Address - Fax:406-322-4607
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice