| NPI | 1639375975 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN S. PARRY President 307-875-7770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 670) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2015-09-24 |