Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 2 | MT |
NPI | 1386746535 |
---|---|
Provider Name | Mr. Ronald Brent Kandarian |
First Address | Kalispell, MT 59901 |
Second Address | Kalispell, MT 59901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150033 | (05) | MT |
7754474 | (05) | MT |