Provider Demographics
NPI:1215298195
Name:MISSOULA GENERAL DENTISTRY, P.C.
Entity type:Organization
Organization Name:MISSOULA GENERAL DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KINNEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-541-3585
Mailing Address - Street 1:3020 S RESERVE ST STE B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7652
Mailing Address - Country:US
Mailing Address - Phone:406-541-3585
Mailing Address - Fax:
Practice Address - Street 1:3020 S RESERVE ST STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7652
Practice Address - Country:US
Practice Address - Phone:406-541-3585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMT2438OtherSTATE OF MONTANA