| NPI | 1033699533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE R JAY Front Office 307-332-3181 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-08-15 |