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Organization

STAR VALLEY DENTAL 1 LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID HOKANSON (OWNER)
(307) 248-0741
Entity
Organization

Contact information

Practice address
725 N WASHINGTON ST, AFTON, WY 83110-1390
(307) 885-4355
Mailing address
PO BOX 1390, AFTON, WY 83110-1390
(307) 885-4355

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
137718300
WY
Enumeration date
12/31/2019
Last updated
12/31/2019
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