# JC DENTISTRY LLC

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

## Provider details

- **NPI number:** 1689117608
- **Authorized official:** DR. JARED B CHRISTOPHERSON DDS (OWNER)
- **Authorized official phone:** (307) 635-6300

## Contact information

- **Practice address:** 229 STOREY BLVD STE A, CHEYENNE, WY 82009-3595
- **Practice address phone:** (307) 635-6300
- **Practice address fax:** (307) 635-6361
- **Mailing address:** 229 STOREY BLVD STE A, CHEYENNE, WY 82009-3595
- **Mailing address phone:** (307) 635-6300
- **Mailing address fax:** (307) 635-6361

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1416 | WY | Yes |

## Other

- **Enumeration date:** 11/22/2016
- **Last updated:** 01/30/2017