# WYOMING COSMETIC AND FAMILY DENTAL

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

## Provider details

- **NPI number:** 1194205401
- **Authorized official:** JASON WHITING DMD (OWNER)
- **Authorized official phone:** (307) 635-2419

## Contact information

- **Practice address:** 4620 GRANDVIEW AVE, SUITE \#101, CHEYENNE, WY 82009
- **Practice address phone:** (307) 635-2419
- **Practice address fax:** (307) 772-3443
- **Mailing address:** 4620 GRANDVIEW AVE, SUITE 101, CHEYENNE, WY 82009
- **Mailing address phone:** (307) 635-2419
- **Mailing address fax:** (307) 772-3443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 1199 | WY | Yes |
| 122300000X | Dentist | 1490 | WY | — |

## Other

- **Enumeration date:** 08/16/2018
- **Last updated:** 08/16/2018