Basic Information
| Provider Information | |||||||||
| NPI: | 1306367313 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BILLINGS ORTHODONTICS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 S 32ND ST W STE A | ||||||||
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| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591026875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062454414 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2910 BIG HORN AVE STE C | ||||||||
| Address2: | |||||||||
| City: | CODY | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824149365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075875451 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | LAMBOURNE | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | CHAD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4062454414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 1395 | WY | N | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223X0400X | 1459 | WY | N | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223X0400X | 1399 | WY | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.