Provider Demographics
NPI:1124237656
Name:HYALITE FAMILY DENTISTRY
Entity type:Organization
Organization Name:HYALITE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-586-4781
Mailing Address - Street 1:1195 STONERIDGE DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7048
Mailing Address - Country:US
Mailing Address - Phone:406-586-4781
Mailing Address - Fax:406-586-5227
Practice Address - Street 1:1195 STONERIDGE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7048
Practice Address - Country:US
Practice Address - Phone:406-586-4781
Practice Address - Fax:406-586-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0005511090Medicaid
MT0000111176Medicaid