Organization
BIGHORN ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH G. MORTENSEN DDS, MSD (OWNER)
(801) 831-2662
Entity
Organization
Contact information
Practice address
642 VAL VISTA ST, SUITE B, SHERIDAN, WY 82801-3659
(307) 672-6917
Mailing address
642 VAL VISTA ST, SUITE B, SHERIDAN, WY 82801-3659
(307) 672-6917
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1344
WY
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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