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Pediatric Dentistry

Cheyenne, Wyoming

Provider NPI: 1477571610

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 307-778-7100  Fax: 307-778-2824

Business Mailing Address:
Tel: 307-778-7100  Fax: 307-778-2824

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0221XDental Providers
Pediatric Dentistry

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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