| NPI | 1114330750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE MARIE RHOADES Dentist 307-746-4772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1301) |
| Additional Taxonomies | 122300000X Dentist (Licence: WY 1264) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |