Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2215 | MT |
Y | 1223P0700X | Prosthodontist | 2215 | MT |
NPI | 1063433985 |
---|---|
Provider Name | Sven Erik Bone |
First Address | Bozeman, MT 59715 |
Second Address | Bozeman, MT 59715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 09/12/2020 |