# JENNIFER DOSER DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Grand Avenue Dental Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073973780
- **Authorized official:** JENNIFER RAE DOSER DMD (PRESIDENT)
- **Authorized official phone:** (307) 742-0722

## Contact information

- **Practice address:** 303 S 8TH ST, LARAMIE, WY 82070-3914
- **Practice address phone:** (307) 742-0722
- **Practice address fax:** (307) 742-0727
- **Mailing address:** 303 S 8TH ST, LARAMIE, WY 82070-3914
- **Mailing address phone:** (307) 742-0722
- **Mailing address fax:** (307) 742-0727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1255 | WY | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 02/24/2016
- **Last updated:** 08/25/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 129817800 | — | WY |