Basic Information
| Provider Information | |||||||||
| NPI: | 1760834956 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BILLINGS ORTHODONTICS, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BENNIONLAMBOURNE ORTHODONTICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 S 32ND ST W | ||||||||
| Address2: | A | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591026875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062454414 | ||||||||
| FaxNumber: | 4062944416 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 S 32ND ST W | ||||||||
| Address2: | A | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591026875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062454414 | ||||||||
| FaxNumber: | 4062944416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2016 | ||||||||
| LastUpdateDate: | 07/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | STEFFES | ||||||||
| AuthorizedOfficialFirstName: | KERRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4062454414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 1635 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
ID Information
| ID | Type | State | Issuer | Description | 1366696809 | 05 | MT | MEDICAID | 1740342682 | 05 | MT | MEDICAID |