| Family Dental Group | |
|
Family Dental Group 2901 Brooks St. Missoula MT 59801-7722 | |
| (406) 541-2886 | |
| (406) 541-2889 |
| Full Name | Family Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | Family Dental Group, Missoula, Montana |
| Authorized Official Name and Position | Shawn D. Modula (GENERAL MANAGER) |
| Authorized Official Contact | 4065412889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Dental Group Family Dental Group 2901 Brooks St. Missoula MT 59801-7722 Ph: (406) 541-2886 | Family Dental Group Family Dental Group 2901 Brooks St. Missoula MT 59801-7722 Ph: (406) 541-2886 |
| NPI Number | 1619970076 |
|---|---|
| Provider Enumeration Date | 05/31/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619970076 | NPI | - | NPPES |
| 5510771 | Medicaid | MT | |
| 0000020164 | Other | MT | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2016 (Montana) | Primary |
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