| NPI | 1881711174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY B KINCHELOE Officer 307-638-8520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1070) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |