| NPI | 1083815989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEELY DANA MORIN Corporate Secretary Treasurer 307-686-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WY 929) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2015-05-26 |