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Organization
TETON ORAL AND MAXILLOFACIAL SURGERY
Active
Organization
TETON ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGET ANNE MULLEN RN (OFFICE MANAGER)
(307) 690-1513
Entity
Organization
Contact information
Practice address
1160 ALPINE LN STE 1D, JACKSON, WY 83001
(307) 739-8611
(307) 739-8613
Mailing address
PO BOX 9339, JACKSON, WY 83002-9339
(307) 739-8611
(307) 739-8613
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
07/09/2018
Last updated
07/26/2018
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