NPIMap

Organization Active NPI

Missoula Pediatric Dentistry PC

  • Pediatric Dentistry
  • Missoula, MT
National Provider Identifier
1942483524
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
MT2151 Issued in MT
Legal business name
MISSOULA PEDIATRIC DENTISTRY PC
Practice address
1300 South Reserve St
Suite B
Missoula, MT 59801
Phone
(406) 541-7334
Fax
(406) 541-7338
NPI assigned
Dec 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

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

Authorized official

Name
Mr. Paul Leonard Tiede
Title
Business Manager
Phone
(406) 541-7334

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X MT2229 MT
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X MT2212 MT
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X MT2151 MT Primary

Addresses

Primary practice location

1300 South Reserve St
Suite B
Missoula, MT 59801

Mailing address

1300 South Reserve St
Suite B
Missoula, MT 59801
Phone (406) 541-7334

Other identifiers 2

IdentifierTypeStateIssuer
1558308221MedicaidMT
5512641OtherMTCHIPS

National Provider Directory

National Provider Directory
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.

Locations

2900 Central Ave
Billings, MT 59102
Phone (406) 656-6100

1300 S Reserve St
Ste B
Missoula, MT 59801
Phone (406) 541-7334

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391126400000",
    "number": "1942483524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 SOUTH RESERVE ST",
            "address_2": "SUITE B",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59801",
            "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": "1300 SOUTH RESERVE ST",
            "address_2": "SUITE B",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59801",
            "telephone_number": "406-541-7334",
            "fax_number": "406-541-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2014-01-31",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "MT2229",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "MT2212",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MT",
            "license": "MT2151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558308221",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIPS",
            "identifier": "5512641",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; 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.