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Organization
ELKRIDGE DENTAL SOUTH LLC
Active
Organization
ELKRIDGE DENTAL SOUTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN TANNER (PRESIDENT)
(503) 866-8454
Entity
Organization
Contact information
Practice address
1315 S HWY 89, JACKSON, WY 83001-8514
(307) 733-4122
Mailing address
PO BOX 1190, JACKSON, WY 83001-1190
(307) 733-2555
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/19/2021
Last updated
10/19/2021
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