Missoula Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

2433 Issued in MT

Legal business name

MISSOULA ORAL SURGERY

Practice address

3020 S Reserve St
Suite C
Missoula, MT 59801-7644

Phone

(406) 552-9970

NPI assigned

Apr 4, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Grant Matthew Wiswell, M.D,, D.D.S

Title

Owner/Surgeon

Phone

(406) 552-9970

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1301875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1301875200000",
    "number": "1255620928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST",
            "address_2": "SUITE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017644",
            "telephone_number": "406-552-9970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST",
            "address_2": "SUITE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017644",
            "telephone_number": "406-552-9970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-04",
        "last_updated": "2011-04-04",
        "status": "A",
        "authorized_official_last_name": "WISWELL",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/SURGEON",
        "authorized_official_telephone_number": "406-552-9970",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D,, D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "MT",
            "license": "2433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in Missoula, MT
• Providers in Missoula, MT by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2011; 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.