Provider Demographics
NPI:1053556084
Name:KALISPELL KIDDS
Entity type:Organization
Organization Name:KALISPELL KIDDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-730-2383
Mailing Address - Street 1:60 FOUR MILE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2663
Mailing Address - Country:US
Mailing Address - Phone:406-756-1142
Mailing Address - Fax:406-756-1143
Practice Address - Street 1:60 FOUR MILE DR STE 10
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2663
Practice Address - Country:US
Practice Address - Phone:406-756-1142
Practice Address - Fax:406-756-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty