Organization
NATHAN TANNER PC
Active
Other names
Elkridge Dental
Organization subpart
No
Provider details
NPI number
Authorized official
LYNETTE KRAUSE (INSURANCE COORDINATOR)
(307) 733-2555
Entity
Organization
Contact information
Practice address
200 E BROADWAY, JACKSON, WY 83001
(307) 733-2555
Mailing address
PO BOX 1190, JACKSON, WY 83001-1190
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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