1629286042 NPI number — CURTIS P. SKILLESTAD DDS, P.C.

Table of content: (NPI 1629286042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629286042 NPI number — CURTIS P. SKILLESTAD DDS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURTIS P. SKILLESTAD DDS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629286042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 S RUSSELL ST
Provider Second Line Business Mailing Address:
SUITE 119
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59801-8574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-543-2998
Provider Business Mailing Address Fax Number:
406-541-2992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 S RUSSELL ST
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59801-8574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-543-2998
Provider Business Practice Location Address Fax Number:
406-541-2992
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SKILLESTAD
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-543-2998

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1968 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0112112 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5511350 . This is a "CHIPS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 72912545 . This is a "TPIN" identifier . This identifiers is of the category "OTHER".




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