Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | MT0014 | MT |
NPI | 1316080625 |
---|---|
Provider Name | Mr. Charles Joseph Conlan |
First Address | Butte, MT 59701 |
Second Address | Butte, MT 59701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |