Provider Demographics
NPI:1497540777
Name:MOOS DENTAL OF MONTANA PLLC
Entity type:Organization
Organization Name:MOOS DENTAL OF MONTANA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-495-5131
Mailing Address - Street 1:379 HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9377
Mailing Address - Country:US
Mailing Address - Phone:715-495-5131
Mailing Address - Fax:
Practice Address - Street 1:1700 W KOCH ST STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4148
Practice Address - Country:US
Practice Address - Phone:406-586-4559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental