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Organization
LANDER DENTAL GROUP,PC
Active
Organization
LANDER DENTAL GROUP,PC
Active
Parent organization
LANDER DENTAL GROUP, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LANDER DENTAL GROUP, PC
Authorized official
CHRIS R PETERSON DDS (PRESIDENT)
(307) 332-7710
Entity
Organization
Contact information
Practice address
799 S 2ND ST, LANDER, WY 82520-3703
(307) 332-7710
Mailing address
799 S 2ND ST, LANDER, WY 82520-3703
(307) 332-7710
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118366400
—
WY
Enumeration date
08/16/2007
Last updated
11/20/2014
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