# ASPEN HILLS DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Livingston Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417351602
- **Authorized official:** JEANELLE ELMOYNE LIVINGSTON RN (OPERATIONS LEADER)
- **Authorized official phone:** (307) 885-4337

## Contact information

- **Practice address:** 800 SOUTH WASHINGTON ST., AFTON, WY 83110
- **Practice address phone:** (307) 885-4337
- **Practice address fax:** (307) 885-4334
- **Mailing address:** 800 SOUTH WASHINGTON ST., 800 SOUTH WASHINGTON, AFTON, WY 83110
- **Mailing address phone:** (307) 885-4337
- **Mailing address fax:** (307) 885-4334

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 910 | WY | Yes |

## Other

- **Enumeration date:** 10/16/2014
- **Last updated:** 04/06/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 112487100 | — | WY |