MISSOULA ORAL SURGERY (NPI# 1255620928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255620928 |
| Entity Type | Organization |
| Organization Name | MISSOULA ORAL SURGERY |
| Practice Address |
3020 S Reserve St Suite C Missoula MT 59801-7644 |
| Practice Telephone | 4065529970 |
| Mailing Telephone | 4065529970 |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |
| Authorized Official Name | DR. GRANT MATTHEW WISWELL (OWNER/SURGEON) |
| Authorized Official Telephone | 4065529970 |
| Authorized Official Credential | M.D,, D.D.S |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
2433 | MT | Ambulatory Health Care Facilities |
| Street Address |
3020 S RESERVE ST SUITE C |
| City | MISSOULA |
| State | MT |
| Zip Code | 59801-7644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578993531 | Missoula Pediatric Dentistry, Pllc | Dentist | 3020 S Reserve St, Suite D, Missoula, MT 59801-7652 | 2013-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681010 | Time To Thrive Pllc | Social Worker | 1836 South Ave. West, Missoula, MT 59801 | 2020-08-26 |
| 1740815653 | Yuzo Fujiki | Specialist/Technologist | 210 N California St 104, Missoula, MT 59801 | 2020-03-11 |
| 1407346596 | Stepping Stones Counseling, Pllc | Counselor | 202 Brooks St Ste 300, Missoula, MT 59801 | 2018-05-14 |
| 1437668530 | Rejuve Care Clinic, Inc | Plastic Surgery | 715 Kensingten, Ste 1, Missoula, Missoula, MT 59801 | 2017-09-21 |
| 1619499555 | Beatrice Elise Powers | Specialist/Technologist | 410 B Stephens Ave, Missoula, MT 59801 | 2017-07-12 |
| 1770012197 | Hannah Lepiane | Massage Therapist | 1313 S. 4th W., Missoula, MT 59801 | 2017-06-08 |
| 1811420227 | Celeste Willis | Social Worker | 1055 W. Sussex, Missoula, MT 59801 | 2017-04-04 |
| 1073050498 | Rina Kasuga | Specialist/Technologist | 913 Rimini Ct, Missoula, MT 59801 | 2017-01-24 |
| 1043756919 | Heather Bartz | Specialist/Technologist | 831 Hastings Ave, Missoula, MT 59801 | 2017-01-16 |
| 1255874517 | Sarabeth Haddad | Social Worker | 1055 W Sussex Ave, Missoula, MT 59801 | 2016-11-18 |
| Find all providers in zip 59801 | ||||
| Taxonomy Code | 261QS0112X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134286883 | Facial Plastic & Reconstructive Surgery Montana PC | Clinic/Center | 805 S Reserve St, Missoula, MT 59801-2104 | 2007-01-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912120817 | State of Montana | Clinic/Center | 1400 Broadway Rm A116, Helena, MT 59620 | 2007-04-10 |
| 1043373012 | Glacier Oral and Maxillofacial Surgery PC | Clinic/Center | 711 13th Str E, Ste 101, Whitefish, MT 59937 | 2006-12-19 |
| 1922103597 | Billings Imaging | Clinic/Center | 152 S 32nd St W, Suite B, Billings, MT 59102-6848 | 2006-09-14 |
| 1811395882 | James A Jerman Dds Pllc | Clinic/Center | 22 2nd Ave W, Suite 1000, Kalispell, MT 59901-4466 | 2014-12-08 |
| 1366748147 | State of Montana | Clinic/Center | 1400 Broadway Rm A116, Helena, MT 59620 | 2011-01-27 |
| 1639475411 | State of Montana | Clinic/Center | 1400 Broadway Rm A116, Helena, MT 59620 | 2011-01-27 |
| 1801093463 | Billings Oral Surgery, LLC | Clinic/Center | 152 S 32nd St W, Suite B, Billings, MT 59102-6848 | 2007-06-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.