Provider Demographics
NPI:1063074524
Name:ELEVATION DENTAL DEER LODGE PLLC
Entity type:Organization
Organization Name:ELEVATION DENTAL DEER LODGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-846-3532
Mailing Address - Street 1:1101 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1807
Mailing Address - Country:US
Mailing Address - Phone:406-846-3532
Mailing Address - Fax:406-846-1885
Practice Address - Street 1:1101 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1807
Practice Address - Country:US
Practice Address - Phone:406-846-3532
Practice Address - Fax:406-846-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental