Missoula Peditric Dentistry, P.C.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4170 Issued in MT

Legal business name

MISSOULA PEDITRIC DENTISTRY, P.C.

Practice address

3020 S Reserve St Ste D
Missoula, MT 59801-7652

Phone

(406) 541-7334

Fax

(406) 541-7338

NPI assigned

Aug 13, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul Leonard Tiede

Title

Business Manager

Phone

(406) 541-7334

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1205183852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST STE D",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-7334",
            "fax_number": "406-541-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST STE D",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-7334",
            "fax_number": "406-541-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA PEDITRIC DENTISTRY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "TIEDE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "LEONARD",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "406-541-7334",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MT",
            "license": "4170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Missoula Osteopathic Clinic, LLC
• Missoula Osteopathic Clinic, PLLC
• Missoula Pediatric Dentistry PC
• Missoula Pediatric Dentistry, PLLC
• Missoula Pediatric Therapy Center Inc
• Missoula Pharmacy Inc
• Missoula Physical Therapy Inc
• Missoula Physical Therapy LLC
• Missoula Play Therapy LLC
• Missoula PT

• Pediatric Dentistry in Missoula, MT
• Providers in Missoula, MT by specialty
• Pediatric Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.