| NPI | 1114291887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIAM A HAMIDI Owner/ Surgeon 307-514-9233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 9281) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2014-12-12 |