1447347869 NPI number — DR. MARY LYNN RUTHERFORD YOUNGBAUER DDS

Table of content: GURVEEN KAUR (NPI 1124432208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447347869 NPI number — DR. MARY LYNN RUTHERFORD YOUNGBAUER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTHERFORD YOUNGBAUER
Provider First Name:
MARY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1447347869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 68
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORSYTH
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59327-0068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-346-2131
Provider Business Mailing Address Fax Number:
406-346-2133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1617 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORSYTH
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59327-0068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-346-2131
Provider Business Practice Location Address Fax Number:
406-346-2133
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  1538 , 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: 15384 . This is a "BLUE CROSS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 5511779 . This is a "STATE OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0138008 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8331 . This is a "STATE BOARD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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