Organization
GRINNELL STREET DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD E. COON D.D.S (GENERAL DENTIST/PRESIDENT)
(307) 672-7567
Entity
Organization
Contact information
Practice address
108 E GRINNELL ST, SHERIDAN, WY 82801-3938
(307) 672-7567
(307) 673-0568
Mailing address
108 E GRINNELL ST, SHERIDAN, WY 82801-3938
(307) 672-7567
(307) 673-0568
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
WY1047
WY
1223G0001X
General Practice Dentistry
WY1085
WY
1223G0001X
General Practice Dentistry
Primary
WY686
WY
Other
Enumeration date
05/15/2012
Last updated
05/15/2012
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