| NPI | 1891127825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINT LEE Dentist 307-686-1567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1175) |
| Additional Taxonomies | 122300000X Dentist (Licence: WY 1345) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2019-04-12 |