# RIVERTON SMILES

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

## Provider details

- **NPI number:** 1770860595
- **Authorized official:** DR. JOSHUA G WAGNER D.D.S (DENTIST)
- **Authorized official phone:** (307) 856-3463

## Contact information

- **Practice address:** 1224 EAST JACKSON AVE, RIVERTON, WY 82501-3841
- **Practice address phone:** (307) 856-3463
- **Practice address fax:** (307) 856-9910
- **Mailing address:** 1224 E JACKSON AVE, RIVERTON, WY 82501-3841
- **Mailing address phone:** (307) 856-3463
- **Mailing address fax:** (307) 856-9910

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1093 | WY | Yes |

## Other

- **Enumeration date:** 11/08/2011
- **Last updated:** 11/08/2011