Doctor Name: | JUSTINE CONLAN |
NPI Number: | 1225172331 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LD |
License Number: | 0025 |
Business Practice Address: | 1103 Missouri Ave Butte, MT - 59701 |
Business Phone Number: | 4067822900 |
Business Fax Number: | 4067822900 |
Mailing Address: | 1103 Missouri Ave, BUTTE |
State: | MT |
Postal Code: | 59701 |
Phone Number: | 4067822900 |
Fax Number: | 4067822900 |
NPI Enumeration Date: | 02/20/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 122400000X |
License Number: | 0025 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Denturist |
Taxonomy Specialization: | |
Taxonomy Definition: |