GLACIER ORAL AND MAXILLOFACIAL SURGERY PC (NPI# 1043373012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043373012 |
| Entity Type | Organization |
| Organization Name | GLACIER ORAL AND MAXILLOFACIAL SURGERY PC |
| Practice Address |
711 13th Str E Ste 101 Whitefish MT 59937 |
| Practice Telephone | 4068625656 |
| Practice Fax Number | 4068626155 |
| Mailing Telephone | 4068625656 |
| Mailing Fax Number | 4068626155 |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2010-03-26 |
| Authorized Official Name | BERNADETTE L WILSON (PRESIDENT) |
| Authorized Official Telephone | 4068625656 |
| Authorized Official Credential | DDS MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
11198 | MT | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | MONTANA DENTAL LICENSE # | 2235 | 01 |
| MT | DEA NUMBER | BW6535617 | 01 |
| MT | MONTANA MEDICAL LICENSE # | 11198 | 01 |
| MT | BLUE CROSS BLUE SHIELD ID | 95296 | 01 |
| MT | 0130186 | 05 |
| Street Address |
711 13TH STR E STE 101 |
| City | WHITEFISH |
| State | MT |
| Zip Code | 59937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265042246 | Gaelen Engler | Social Worker | 144 2nd St, Whitefish, MT 59937 | 2020-08-05 |
| 1649818808 | Columbia Falls Family Dental Center PC | Dentist | 6360 Us Hwy 93 South, Whitefish, MT 59937 | 2019-12-18 |
| 1962040220 | Jordan Gilbert | Social Worker | 144-a Second Street West, Whitefish, MT 59937 | 2019-12-18 |
| 1821652819 | Jordan Fiorillo Scotti | Psychologist | 144 2nd Street, Whitefish, MT 59937 | 2019-04-25 |
| 1982195772 | Elizabeth Thomas | Massage Therapist | 6475 Highway 93 South, Ste 22, Whitefish, MT 59937 | 2018-05-29 |
| 1205349032 | Lindsey Marie Jordan | Counselor | 1143 4th St, Whitefish, MT 59937 | 2017-11-15 |
| 1023547916 | Leah Hanson | Massage Therapist | 505 Spokane, Whitefish, MT 59937 | 2017-06-05 |
| 1992106579 | Julie Ogle | Occupational Therapist | 1305 E. 7th Street, Genesis Healthcare Whitefish Center, Whitefish, MT 59937 | 2014-09-15 |
| 1588081012 | Dina Marie Deeds | Registered Nurse | 600 8th Street East, Whitefish, MT 59937 | 2014-03-21 |
| 1376809061 | North Valley Hospital, Inc | Clinic/Center | 3004 Hospital Way, Whitefish, MT 59937 | 2012-04-06 |
| Find all providers in zip 59937 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255620928 | Missoula Oral Surgery | Clinic/Center | 3020 S Reserve St, Suite C, Missoula, MT 59801-7644 | 2011-04-04 |
| 1912120817 | State of Montana | Clinic/Center | 1400 Broadway Rm A116, Helena, MT 59620 | 2007-04-10 |
| 1922103597 | Billings Imaging | Clinic/Center | 152 S 32nd St W, Suite B, Billings, MT 59102-6848 | 2006-09-14 |
| 1811395882 | James A Jerman Dds Pllc | Clinic/Center | 22 2nd Ave W, Suite 1000, Kalispell, MT 59901-4466 | 2014-12-08 |
| 1366748147 | State of Montana | Clinic/Center | 1400 Broadway Rm A116, Helena, MT 59620 | 2011-01-27 |
| 1639475411 | State of Montana | Clinic/Center | 1400 Broadway Rm A116, Helena, MT 59620 | 2011-01-27 |
| 1801093463 | Billings Oral Surgery, LLC | Clinic/Center | 152 S 32nd St W, Suite B, Billings, MT 59102-6848 | 2007-06-28 |
| 1134286883 | Facial Plastic & Reconstructive Surgery Montana PC | Clinic/Center | 805 S Reserve St, Missoula, MT 59801-2104 | 2007-01-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.