Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 26 | MT |
NPI | 1417133026 |
---|---|
Provider Name | Kristen Heather Tinervin |
First Address | Missoula, MT 59801-6659 |
Second Address | Missoula, MT 59801-6659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 14/01/2008 |