Missoula Pediatric Dentistry, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

MT2151 Issued in MT

Legal business name

MISSOULA PEDIATRIC DENTISTRY, PLLC

Practice address

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

Phone

(406) 541-7334

Fax

(406) 541-7338

NPI assigned

Nov 12, 2013

Organization subpart

No

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

Authorized official

Name

Paul Leonard Tiede

Title

Business Manager

Phone

(406) 541-7334

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Missoula Pediatric Dentistry PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Missoula Pediatric Dentistry PC

  • Pediatric Dentistry
  • Missoula, MT
  • NPI 1942483524
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan Bon Tiede, D.D.S.

  • Pediatric Dentistry
  • Missoula, MT
  • NPI 1558308221
  NPD

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

{
    "created_epoch": "1384214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384214400000",
    "number": "1578993531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST",
            "address_2": "SUITE 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",
            "address_2": "SUITE D",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-7334",
            "fax_number": "406-541-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA PEDIATRIC DENTISTRY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-12",
        "last_updated": "2013-11-12",
        "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"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MT",
            "license": "MT2151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942483524",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Missoula Oral Surgery
• Missoula Orthotics & Prosthetics Laboratory, Inc (Hanger Clinic)
• Missoula Osteopathic Clinic, LLC
• Missoula Osteopathic Clinic, PLLC
• Missoula Pediatric Dentistry PC
• Missoula Pediatric Therapy Center Inc (Kidzoola Therapy Center)
• Missoula Peditric Dentistry, P.C.
• Missoula Pharmacy Inc (Missoula Pharmacy)
• Missoula Physical Therapy Inc
• Missoula Physical Therapy LLC

• 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 Nov 12, 2013; 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.