| Blacktail Dental | |
|
125 E Glendale St Dillon MT 59725-2505 | |
| (406) 683-4440 | |
| (406) 683-1121 |
| Full Name | Blacktail Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 125 E Glendale St, Dillon, Montana |
| Authorized Official Name and Position | Kayla Medina (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 4064966045 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blacktail Dental 445 Centennial Ave Butte MT 59701-2870 Ph: (406) 496-6045 | Blacktail Dental 125 E Glendale St Dillon MT 59725-2505 Ph: (406) 683-4440 |
| NPI Number | 1235238718 |
|---|---|
| Provider Enumeration Date | 09/21/2006 |
| Last Update Date | 02/12/2026 |
| Certification Date | 02/12/2026 |
| Medicare PECOS PAC ID | 3870402845 |
|---|---|
| Medicare Enrollment ID | O20030410000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235238718 | NPI | - | NPPES |
| 0730028 | Medicaid | MT | |
| 63392 | Other | MT | BCBS |
| CK5130 | Other | MT | RAILROAD MEDICARE |
| 95601016 | Other | MT | MT BREAST & CERVICAL PROG |
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