Active NPI
Glacier Oral and Maxillofacial Surgery PC
- Oral and Maxillofacial Surgery Clinic/Center
- Whitefish, MT
National Provider Identifier
1043373012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery Clinic/Center
- License
- 11198
- Legal business name
- GLACIER ORAL AND MAXILLOFACIAL SURGERY PC
- Practice address
- 711 13TH STR E
Ste 101
Whitefish, MT 59937 - Phone
- (406) 862-5656
- Fax
- (406) 862-6155
- NPI assigned
- Dec 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bernadette L Wilson, DDS MD
- Title
- President
- Phone
- (406) 862-5656
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery Clinic/Center | 261QS0112X | 11198 | MT | Primary |
Addresses
Primary practice location
711 13TH STR E
Ste 101
Whitefish, MT 59937
Mailing address
711 13TH STR E
Ste 101
Whitefish, MT 59937
Phone (406) 862-5656
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0130186 | Medicaid | MT | |
| 95296 | Other | MT | BLUE CROSS BLUE SHIELD ID |
| 2235 | Other | MT | MONTANA DENTAL LICENSE # |
| 11198 | Other | MT | MONTANA MEDICAL LICENSE # |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1043373012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 13TH STR E",
"address_2": "STE 101",
"city": "WHITEFISH",
"state": "MT",
"postal_code": "59937",
"telephone_number": "406-862-5656",
"fax_number": "406-862-6155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 13TH STR E",
"address_2": "STE 101",
"city": "WHITEFISH",
"state": "MT",
"postal_code": "59937",
"telephone_number": "406-862-5656",
"fax_number": "406-862-6155"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GLACIER ORAL AND MAXILLOFACIAL SURGERY PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-19",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "WILSON",
"authorized_official_first_name": "BERNADETTE",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "406-862-5656",
"authorized_official_credential": "DDS MD"
},
"taxonomies": [
{
"code": "261QS0112X",
"taxonomy_group": "",
"desc": "Clinic/Center, Oral and Maxillofacial Surgery",
"state": "MT",
"license": "11198",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0130186",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD ID",
"identifier": "95296",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MONTANA DENTAL LICENSE #",
"identifier": "2235",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MONTANA MEDICAL LICENSE #",
"identifier": "11198",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whitefish, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.