Provider Demographics
NPI:1427074053
Name:JEFF A DALEN DDS PLLC
Entity type:Organization
Organization Name:JEFF A DALEN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-862-4301
Mailing Address - Street 1:PO BOX 4909
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-4909
Mailing Address - Country:US
Mailing Address - Phone:406-862-4301
Mailing Address - Fax:406-862-9347
Practice Address - Street 1:6345 US HIGHWAY 93 S
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8236
Practice Address - Country:US
Practice Address - Phone:406-862-4301
Practice Address - Fax:406-862-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13811223G0001X
MT21751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0112217Medicaid
MT000084728Medicare ID - Type Unspecified