| Misa04, LLC | |
|
3020 S Reserve St Missoula MT 59801-7652 | |
| (406) 697-5756 | |
| Not Available |
| Full Name | Misa04, LLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3020 S Reserve St, Missoula, Montana |
| Authorized Official Name and Position | William Winterholler (OWNER) |
| Authorized Official Contact | 4066975756 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Misa04, LLC 683 Henry Chapple St Billings MT 59106-1839 | Misa04, LLC 3020 S Reserve St Missoula MT 59801-7652 Ph: (406) 697-5756 |
| NPI Number | 1588366611 |
|---|---|
| Provider Enumeration Date | 03/21/2023 |
| Last Update Date | 03/21/2023 |
| Certification Date | 03/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588366611 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
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