Provider Demographics
NPI:1841839230
Name:TRAILHEAD PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:TRAILHEAD PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-248-3303
Mailing Address - Street 1:1601 ZIMMERMAN TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7654
Mailing Address - Country:US
Mailing Address - Phone:406-248-3303
Mailing Address - Fax:406-248-3939
Practice Address - Street 1:513 HILLTOP RD STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-2375
Practice Address - Country:US
Practice Address - Phone:406-248-3303
Practice Address - Fax:406-248-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty