Provider Demographics
NPI:1144527508
Name:SUNSET DENTAL CARE PC
Entity type:Organization
Organization Name:SUNSET DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCHUYLER
Authorized Official - Middle Name:A
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-278-3609
Mailing Address - Street 1:417 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-1901
Mailing Address - Country:US
Mailing Address - Phone:406-278-3609
Mailing Address - Fax:406-278-5458
Practice Address - Street 1:417 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-1901
Practice Address - Country:US
Practice Address - Phone:406-278-3609
Practice Address - Fax:406-278-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1880332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0112438Medicaid