Makenzie Nicole Bagnell, DDS
Individual provider Active NPI Dentist · Bigfork, MT
NPI 1104574599 · NPPES record last updated Oct 10, 2024
Key facts
- NPI
- 1104574599
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN-DEN-LIC-23639 (MT)
- Practice address
- 33 Doc Kimball Way
Bigfork, MT 59911-6491 - Phone
- (406) 614-2020
- NPI assigned
- Mar 14, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN-DEN-LIC-23639 | MT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jewel Basin Dentistry | Dentist | Current |
Accepting new patients |
Locations
33 Doc Kimball Way
Bigfork, MT 59911
Phone (406) 261-6430
1608 Main St
Thompson Falls, MT 59873
Phone (406) 827-4681
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DEN-DEN-LIC-23639 | MT | Yes |
Addresses
Primary practice location
33 Doc Kimball Way
Bigfork, MT 59911-6491
Mailing address
33 Doc Kimball Way
Bigfork, MT 59911-6491
Other names
- Makenzie Nicole Thuringer
Other providers in Bigfork, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.