Active NPI
Eugene Bollwitt
- General Practice Dentistry
- Great Falls, MT
National Provider Identifier
1760604821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1786
- Practice address
- 3224 10TH Ave S
Great Falls, MT 59405-3449 - Phone
- (406) 727-1006
- NPI assigned
- May 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1786 | MT | Primary |
Addresses
Primary practice location
3224 10TH Ave S
Great Falls, MT 59405-3449
Mailing address
PO Box 7050
Great Falls, MT 59406-7050
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17864 | Other | MT | BCBS # |
| 5512284 | Other | MT | CHIP # |
| 1786 | Other | MT | DELTA # |
| 0112659 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1786 | MT | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bruk P. Weymouth, DDS, PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Family Dental Center
- General Practice Dentistry
- Great Falls, MT
- NPI 1053462341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760604821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7050",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594067050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3224 10TH AVE S",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594053449",
"telephone_number": "406-727-1006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLWITT",
"first_name": "EUGENE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MT",
"license": "1786",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS #",
"identifier": "17864",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIP #",
"identifier": "5512284",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA #",
"identifier": "1786",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0112659",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.