Provider Demographics
NPI:1124626262
Name:HAVRE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:HAVRE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-449-0189
Mailing Address - Street 1:515 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5121
Mailing Address - Country:US
Mailing Address - Phone:406-235-5218
Mailing Address - Fax:
Practice Address - Street 1:515 14TH ST W
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5121
Practice Address - Country:US
Practice Address - Phone:406-235-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty