Provider Demographics
NPI:1316716160
Name:ALEAGHA PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:ALEAGHA PEDIATRIC DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-587-5437
Mailing Address - Street 1:1039 STONERIDGE DR.
Mailing Address - Street 2:STE. 1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-587-5437
Mailing Address - Fax:406-577-2172
Practice Address - Street 1:1039 STONERIDGE DR.
Practice Address - Street 2:STE. 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-587-5437
Practice Address - Fax:406-577-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty