# PINEDALE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033870779
- **Authorized official:** ALISON PETERSEN (RECEPTIONIST)
- **Authorized official phone:** (307) 367-3700

## Contact information

- **Practice address:** 33 FREMONT LAKE RD, PINEDALE, WY 82941-5213
- **Practice address phone:** (307) 367-3700
- **Practice address fax:** (307) 312-2848
- **Mailing address:** PO BOX 1190, PINEDALE, WY 82941-1190
- **Mailing address phone:** (307) 367-3700
- **Mailing address fax:** (307) 312-2848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/05/2022
- **Last updated:** 01/05/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 113694100 | — | WY |
| 05 | — | 207753100 | — | WY |