Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2054 | MT |
NPI | 1003153560 |
---|---|
Provider Name | Dr. Amy Lacy Claeys |
First Address | Helena, MT 59602-0543 |
Second Address | Helena, MT 59602-0543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2013 |
Last Update Date | 03/01/2013 |