# STAR VALLEY ORAL SURGERY

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

## Provider details

- **NPI number:** 1821610957
- **Authorized official:** DR. MARK WESTON JOHNSON DMD (PRESIDENT)
- **Authorized official phone:** (307) 883-4222

## Contact information

- **Practice address:** 487 N MAIN, SUITE B, THAYNE, WY 83127
- **Practice address phone:** (307) 883-4222
- **Practice address fax:** (307) 883-4222
- **Mailing address:** PO BOX 1365, THAYNE, WY 83127-1365
- **Mailing address phone:** (307) 883-4222
- **Mailing address fax:** (307) 883-4223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2020
- **Last updated:** 05/12/2020