NPI | 1891186151 |
---|---|
Entity Type | Organization |
Authorized Contact | TERRY RODGERS Pracrice Administrator 307-383-0959 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MD 13338) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 15002) |
122300000X Dentist (Licence: MD 14110) | |
122300000X Dentist (Licence: MD 15191) | |
122300000X Dentist (Licence: MD 13602) | |
Enumeration Date | 2015-02-09 |
Last Update Date | 2015-02-09 |