| Peter Ivey LLC | |
|
555 Corporate Dr Ste 204 Kalispell MT 59901-6138 | |
| (530) 277-3607 | |
| (406) 309-6141 |
| Full Name | Peter Ivey LLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 555 Corporate Dr Ste 204, Kalispell, Montana |
| Authorized Official Name and Position | Peter Ivey (OWNER) |
| Authorized Official Contact | 5302773607 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter Ivey LLC 511 4th Ave E Kalispell MT 59901-4914 Ph: (530) 277-3607 | Peter Ivey LLC 555 Corporate Dr Ste 204 Kalispell MT 59901-6138 Ph: (530) 277-3607 |
| NPI Number | 1689437436 |
|---|---|
| Provider Enumeration Date | 02/05/2024 |
| Last Update Date | 06/20/2025 |
| Certification Date | 06/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689437436 | NPI | - | NPPES |
| 193400000X | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Secondary |
| 1223G0001X | Dentist - General Practice | () | Primary |
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