| NPI | 1740776202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIDGET ANNE MULLEN Office Manager 307-690-1513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-07-26 |