| NPI | 1902098528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS R PETERSON President 307-332-7710 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2014-11-20 |