| NPI | 1154523728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRIK P WALTON President 307-587-2951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1008 & 1135) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |