| 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 |