# KINCHELOE DENTAL OFFICE, PC

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

## Provider details

- **NPI number:** 1881711174
- **Authorized official:** DR. BRADLEY B KINCHELOE DDS (OFFICER)
- **Authorized official phone:** (307) 638-8520

## Contact information

- **Practice address:** 6244 YELLOWSTONE RD, CHEYENNE, WY 82009-3432
- **Practice address phone:** (307) 638-8520
- **Mailing address:** 2625 WILDHORSE TRL, CHEYENNE, WY 82009-2232
- **Mailing address phone:** (307) 638-6544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1070 | WY | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 08/22/2020