| NPI | 1063664795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRY HANCOCK Office Manager 307-789-9034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 715) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2008-10-13 |