| NPI | 1356630057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCAS A HARDY Owner 307-235-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY 1146) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY 1265) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |