Provider Demographics
NPI:1841648227
Name:MEADOWLARK DENTAL CARE PLLC
Entity type:Organization
Organization Name:MEADOWLARK DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-543-0300
Mailing Address - Street 1:628 SOUTH AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8020
Mailing Address - Country:US
Mailing Address - Phone:406-543-0300
Mailing Address - Fax:
Practice Address - Street 1:628 SOUTH AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8020
Practice Address - Country:US
Practice Address - Phone:406-543-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1739122300000X
MT9630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty