NPI: 1740546100 · BOULDER, MT 59632 · Dental Clinic/Center · NPI assigned 04/10/2012
| Authorized Official | MARTIN, CHARISSA (OWNER) |
| NPI Enumeration Date | 04/10/2012 |
Other providers sharing the same authorized official: MARTIN, CHARISSA
| Provider | City | State | Total Paid |
|---|---|---|---|
| QUEEN CITY DENTAL STUDIO | HELENA | MT | $3K |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 14 | $689.64 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 14 | 14 | $689.64 |