| NPI | 1891871471 |
|---|---|
| Former Legal Business Name | MICHAEL G SHANE DDS |
| Entity Type | Organization |
| Authorized Contact | MICHAEL GEORGE SHANE President 307-332-3181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WY 926) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-18 |