Provider Demographics
NPI:1487299855
Name:INTO THE GROOVE
Entity type:Organization
Organization Name:INTO THE GROOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RDH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, LAP
Authorized Official - Phone:406-490-7392
Mailing Address - Street 1:4925 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-7047
Mailing Address - Country:US
Mailing Address - Phone:406-490-7392
Mailing Address - Fax:
Practice Address - Street 1:4925 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-7047
Practice Address - Country:US
Practice Address - Phone:406-490-7392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty