| NPI | 1881194280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA ANN HAEFELE Dentist/Owner 307-337-3717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WY 1316) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-02-13 |