Provider Demographics
NPI:1245687250
Name:GABRIEL MCCORMICK DMD PLLC
Entity type:Organization
Organization Name:GABRIEL MCCORMICK DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-586-7661
Mailing Address - Street 1:115 W KAGY BLVD
Mailing Address - Street 2:STE I
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6027
Mailing Address - Country:US
Mailing Address - Phone:406-586-7661
Mailing Address - Fax:406-586-7662
Practice Address - Street 1:115 W KAGY BLVD
Practice Address - Street 2:STE I
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6027
Practice Address - Country:US
Practice Address - Phone:406-586-7661
Practice Address - Fax:406-586-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty