| NPI | 1104308030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATHEW MOSS Owner 307-587-9009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1133) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2018-09-06 |