Elijah Jacob Grayson
Individual provider Active NPI Dental Assistant · Malmstrom Afb, MT
NPI 1356917850 · NPPES record last updated Jun 3, 2021
Key facts
- NPI
- 1356917850
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Assistant 126800000X
- Practice address
- 7300 N Perimeter Rd
Malmstrom Afb, MT 59402-6701 - Phone
- (406) 731-2511
- NPI assigned
- Jun 3, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | Yes |
Addresses
Primary practice location
7300 N Perimeter Rd
Malmstrom Afb, MT 59402-6701
Mailing address
7300 N Perimeter Rd
Malmstrom Afb, MT 59402-6701
Phone (406) 731-2511
Other providers in Malmstrom Afb, MT
- Rachel Elder
- Paxton Anne Farias
- Daniel Ray Fisher
- Tyler Freeman
- Timothy Paul Gacioch
- Laurie Carrin Harper
- Elaine Harris
- Jennifer Bradley Harward
- Editha P. Heberlein
- Anjelisa Marie Howard
All providers in Malmstrom Afb, MT · Dental Assistant in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2021. 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.