Organization · NPI-2

3 Rivers Pediatric Dentistry

Dentist, Pediatric Dentistry · Missoula, MT

NPI number1578081428

StatusActive

Last updated in NPPESFeb 8, 2021

Details

NPI: 1578081428
Entity type: Organization (NPI-2)
Legal business name: 3 Rivers Pediatric Dentistry
Organization subpart: No
Enumeration date: Aug 30, 2017
Certification date: Feb 8, 2021
Last updated: Feb 8, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
1223P0221X	Dentist, Pediatric Dentistry	–	–	Yes

Practice location

2680 Washburn St.
Missoula, MT 59801-7831

Phone 406-393-3773 · Fax 406-926-2671

Mailing address

2680 Washburn St.
Missoula, MT 59801-7831

Phone 406-393-3773 · Fax 406-926-2671

Authorized official

Angella Marie Winters
Practice Manager
4063933773

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