Sapphire Dental Group, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2016 Issued in MT

Legal business name

SAPPHIRE DENTAL GROUP, PC

Practice address

Family Dental Group
2901 Brooks St.
Missoula, MT 59801-7722

Phone

(406) 541-2886

Fax

(406) 541-2889

NPI assigned

May 31, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Shawn D. Modula

Title

General Manager

Phone

(406) 541-2889

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Family Dental Group Doing business as

Locations

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619970076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FAMILY DENTAL GROUP",
            "address_2": "2901 BROOKS ST.",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017722",
            "telephone_number": "406-541-2886",
            "fax_number": "406-541-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FAMILY DENTAL GROUP",
            "address_2": "2901 BROOKS ST.",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017722",
            "telephone_number": "406-541-2886",
            "fax_number": "406-541-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAPPHIRE DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MODULA",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "406-541-2889",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "2016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5510771",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0000020164",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sandy Sheppard OD PC
• Kaye M Sankey, RN-C
• Emily Santaw, MS CF-SLP
• Mark L. Sanz, MD
• Phyllis Sapienza
• Sapphire Lifts and Mobility
• Sapphire Physical Therapy
• Sapphire Physical Therapy, PC
• Sara Curtin Counseling, PLLC
• Sarah Lafont Counseling Arts

• General Practice Dentistry in Missoula, MT
• Providers in Missoula, MT by specialty
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.