Provider Demographics
NPI:1962430124
Name:SPAINHOWER, STEVEN L (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:SPAINHOWER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W KAGY BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6027
Mailing Address - Country:US
Mailing Address - Phone:406-587-4221
Mailing Address - Fax:406-586-0555
Practice Address - Street 1:115 W KAGY BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6027
Practice Address - Country:US
Practice Address - Phone:406-587-4221
Practice Address - Fax:406-586-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA55695OtherUNITED CONCORDIA-TRICARE
MT5510050Medicaid
MT0120159Medicaid