Provider Demographics
NPI:1861528457
Name:DENDRINOS, KLEANTHIS G (MD)
Entity type:Individual
Prefix:
First Name:KLEANTHIS
Middle Name:G
Last Name:DENDRINOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-5000
Mailing Address - Fax:
Practice Address - Street 1:875 S COTTONWOOD RD STE 200
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4208
Practice Address - Country:US
Practice Address - Phone:406-414-5336
Practice Address - Fax:406-414-5337
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7943A207RG0100X
MTMED-PHYS-LIC-58486207RG0100X
MA220124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1861528457Medicaid
WY22018Medicare PIN