| NPI | 1346596376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LYNNE CASSITY Dentist 307-234-3100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1113) |
| Additional Taxonomies | 122300000X Dentist (Licence: WY 1318) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2012-07-27 |