Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 10388 | MT |
N | 208600000X | Surgeon | 10388 | MT |
Y | 2086S0129X | Vascular Surgeon | 10388 | MT |
NPI | 1003979550 |
---|---|
Provider Name | Dr. Bennett Jon Dykstra |
First Address | Kalispell, MT 59901-4844 |
Second Address | Kalispell, MT 59901-4844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 26/06/2020 |