Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 24 | MT |
NPI | 1285799353 |
---|---|
Provider Name | Remi Armand Berube |
First Address | Missoula, MT 59801-6659 |
Second Address | Missoula, MT 59801-6659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |