# LANDER DENTAL GROUP,PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LANDER DENTAL GROUP, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902098528
- **Legal business name:** LANDER DENTAL GROUP, PC
- **Authorized official:** CHRIS R PETERSON DDS (PRESIDENT)
- **Authorized official phone:** (307) 332-7710

## Contact information

- **Practice address:** 799 S 2ND ST, LANDER, WY 82520-3703
- **Practice address phone:** (307) 332-7710
- **Mailing address:** 799 S 2ND ST, LANDER, WY 82520-3703
- **Mailing address phone:** (307) 332-7710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2007
- **Last updated:** 11/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 118366400 | — | WY |