Organization
CHEYENNE FACIAL IMAGING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON L. BIRD DDS (ORTHODONTIST)
(307) 316-4101
Entity
Organization
Contact information
Practice address
1401 AIRPORT PKWY STE 210, CHEYENNE, WY 82001-1541
(307) 316-4101
(307) 224-1089
Mailing address
1401 AIRPORT PKWY STE 210, CHEYENNE, WY 82001-1541
(307) 316-4101
(307) 224-1089
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
999
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121770400
—
WY
Enumeration date
11/10/2015
Last updated
11/10/2015
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