| Coburn Dental Office Llc | |
|
116 N Meade Ave Glendive MT 59330-1604 | |
| (406) 377-8265 | |
| (406) 377-8267 |
| Full Name | Coburn Dental Office Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 116 N Meade Ave, Glendive, Montana |
| Authorized Official Name and Position | Richard Ryan Coburn (OWNER) |
| Authorized Official Contact | 4063778265 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coburn Dental Office Llc 116 N Meade Ave Glendive MT 59330-1604 Ph: (406) 377-8265 | Coburn Dental Office Llc 116 N Meade Ave Glendive MT 59330-1604 Ph: (406) 377-8265 |
| NPI Number | 1770831539 |
|---|---|
| Provider Enumeration Date | 08/27/2012 |
| Last Update Date | 11/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770831539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2288 (Montana) | Primary |
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