| NPI | 1326059791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY K NELSON President/Owner 307-347-2544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1118) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WY 573) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2015-06-10 |