| NPI | 1053058651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE LAMBERT Owner 307-287-0729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2022-05-16 |