Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 021 | MT |
NPI | 1376607663 |
---|---|
Provider Name | Mr. Grant Arthur Olson |
First Address | Billings, MT 59102-2940 |
Second Address | Billings, MT 59102-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0150229 | (05) | MT |