Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 189 | MT |
NPI | 1043518640 |
---|---|
Provider Name | Colleen G Grass |
First Address | Helena, MT 59602-6011 |
Second Address | Helena, MT 59602-6011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2011 |
Last Update Date | 05/03/2011 |