406 Periodontics, PLLC
Dentist, Periodontics in Bozeman, MT. Organization (NPI-2).
NPI number1215655725
StatusActive
Last updated in NPPESAug 19, 2022
Details
- NPI
- 1215655725
- Entity type
- Organization (NPI-2)
- Legal business name
- 406 Periodontics, PLLC
- Organization subpart
- No
- Enumeration date
- Aug 19, 2022
- Certification date
- Aug 19, 2022
- Last updated
- Aug 19, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223P0300X | Dentist, Periodontics | – | – | Yes |
Practice location
1648 Ellis St Ste 202Bozeman, MT 59715-8811
Phone 406-414-1303 · Fax 406-577-2142
Mailing address
1648 Ellis St Ste 202Bozeman, MT 59715-8811
Phone 206-931-4221
Authorized official
Jessica R Swoboda
Owner/Member
2069314221
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