Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | MT DENTURIST 22 | MT |
NPI | 1235352121 |
---|---|
Provider Name | Allen L Casteel |
First Address | Great Falls, MT 59404-1937 |
Second Address | Great Falls, MT 59404-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000030314 | BCBS (01) | MT |
0150178 | (05) | MT |
5512471 | CHIP (01) | MT |