Provider Demographics
NPI:1386001444
Name:SIDNEY DENTAL LLC
Entity type:Organization
Organization Name:SIDNEY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCO
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-482-2666
Mailing Address - Street 1:1405 4TH ST SW
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270
Mailing Address - Country:US
Mailing Address - Phone:406-482-2666
Mailing Address - Fax:
Practice Address - Street 1:1405 4TH ST SW
Practice Address - Street 2:SUITE 4
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3515
Practice Address - Country:US
Practice Address - Phone:406-482-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT96551223G0001X
MT13801223G0001X
MT24251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty