| NPI | 1104207927 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL WOOD Office Manager 307-877-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 813) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2015-06-17 |