Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DEN-DEN-LIC-21421 | MT |
NPI | 1003484619 |
---|---|
Provider Name | Brady Kimball |
First Address | Helena, MT 59601-9684 |
Second Address | Billings, MT 59102-6258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 11/06/2021 |