Provider Demographics
NPI:1285799353
Name:BERUBE, REMI ARMAND (LD)
Entity type:Individual
Prefix:
First Name:REMI
Middle Name:ARMAND
Last Name:BERUBE
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STEPHENS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6659
Mailing Address - Country:US
Mailing Address - Phone:406-829-8900
Mailing Address - Fax:406-829-8909
Practice Address - Street 1:2100 STEPHENS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6659
Practice Address - Country:US
Practice Address - Phone:406-829-8900
Practice Address - Fax:406-829-8909
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist