Sapphire Dental Group, PC
Dentist, General Practice in Missoula, MT. Organization (NPI-2).
NPI number1619970076
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1619970076
- Entity type
- Organization (NPI-2)
- Legal business name
- Sapphire Dental Group, PC
- Organization subpart
- No
- Enumeration date
- May 31, 2005
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 2016 | MT | Yes |
Other names
- Family Dental Group (Doing Business As)
Practice location
Family Dental Group2901 Brooks St.
Missoula, MT 59801-7722
Phone 406-541-2886 · Fax 406-541-2889
Mailing address
Family Dental Group2901 Brooks St.
Missoula, MT 59801-7722
Phone 406-541-2886 · Fax 406-541-2889
Authorized official
Shawn D. Modula
General Manager
4065412889
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