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Individual

DR. CLYDE WALLACE STOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
156 COUNTY ROAD 114, FREEDOM, WY 83120
(307) 880-2760
Mailing address
PO BOX 227, FREEDOM, WY 83120
(307) 880-2760

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
472
WY

Other

Enumeration date
01/29/2013
Last updated
01/29/2013
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