Provider Demographics
NPI:1952974594
Name:SOUTHWESTERN MONTANA ORAL AND MAXILLOFACIAL SURGERY LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN MONTANA ORAL AND MAXILLOFACIAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-490-8204
Mailing Address - Street 1:105 BLACKTAIL CT
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4351
Mailing Address - Country:US
Mailing Address - Phone:406-490-8204
Mailing Address - Fax:
Practice Address - Street 1:307 E PARK AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2320
Practice Address - Country:US
Practice Address - Phone:406-563-3473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty