| NPI | 1639792450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RILEY JARED HICKS Dental Specialist/ Owner 307-201-5668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-05-27 |