# GRINNELL STREET DENTAL GROUP

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

## Provider details

- **NPI number:** 1194084897
- **Authorized official:** DR. DONALD E. COON D.D.S (GENERAL DENTIST/PRESIDENT)
- **Authorized official phone:** (307) 672-7567

## Contact information

- **Practice address:** 108 E GRINNELL ST, SHERIDAN, WY 82801-3938
- **Practice address phone:** (307) 672-7567
- **Practice address fax:** (307) 673-0568
- **Mailing address:** 108 E GRINNELL ST, SHERIDAN, WY 82801-3938
- **Mailing address phone:** (307) 672-7567
- **Mailing address fax:** (307) 673-0568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | WY1047 | WY | — |
| 1223G0001X | General Practice Dentistry | WY1085 | WY | — |
| 1223G0001X | General Practice Dentistry | WY686 | WY | Yes |

## Other

- **Enumeration date:** 05/15/2012
- **Last updated:** 05/15/2012