Organization
PINEDALE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISON PETERSEN (RECEPTIONIST)
(307) 367-3700
Entity
Organization
Contact information
Practice address
33 FREMONT LAKE RD, PINEDALE, WY 82941-5213
(307) 367-3700
(307) 312-2848
Mailing address
PO BOX 1190, PINEDALE, WY 82941-1190
(307) 367-3700
(307) 312-2848
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113694100
—
WY
05
—
207753100
—
WY
Enumeration date
01/05/2022
Last updated
01/05/2022
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