# JACKSON FAMILY DENTISTRY

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

## Provider details

- **NPI number:** 1457485732
- **Authorized official:** MR. CARY G. SMITH D.M.D (GENERAL PARTNER)
- **Authorized official phone:** (307) 733-7044

## Contact information

- **Practice address:** 1115 MAPLEWAY, JACKSON, WY 83001
- **Practice address phone:** (307) 733-7044
- **Practice address fax:** (307) 734-1409
- **Mailing address:** PO BOX 9248, JACKSON, WY 83002-9248
- **Mailing address phone:** (307) 733-7044
- **Mailing address fax:** (307) 734-1409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 756 | WY | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 03/28/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 112319000 | — | WY |