Provider Demographics
NPI:1427296839
Name:MIHELIC-KLEMANN, DIANE MARIE (RDH,BA)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:MIHELIC-KLEMANN
Suffix:
Gender:F
Credentials:RDH,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 CHERRY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3599
Mailing Address - Country:US
Mailing Address - Phone:406-698-7874
Mailing Address - Fax:
Practice Address - Street 1:516 CHERRY HILLS RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3535
Practice Address - Country:US
Practice Address - Phone:406-698-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT574124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist