# TETON ORAL AND MAXILLOFACIAL SURGERY

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

## Provider details

- **NPI number:** 1740776202
- **Authorized official:** BRIDGET ANNE MULLEN RN (OFFICE MANAGER)
- **Authorized official phone:** (307) 690-1513

## Contact information

- **Practice address:** 1160 ALPINE LN STE 1D, JACKSON, WY 83001
- **Practice address phone:** (307) 739-8611
- **Practice address fax:** (307) 739-8613
- **Mailing address:** PO BOX 9339, JACKSON, WY 83002-9339
- **Mailing address phone:** (307) 739-8611
- **Mailing address fax:** (307) 739-8613

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 07/09/2018
- **Last updated:** 07/26/2018