Organization
SOH OF WYOMING LLC
Active
Other names
Westgate Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SAMSON LIU (MANAGER)
(217) 821-7960
Entity
Organization
Contact information
Practice address
121 W CARLSON ST, CHEYENNE, WY 82009-4044
(307) 635-1197
Mailing address
121 W CARLSON ST, CHEYENNE, WY 82009-4044
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
11/12/2021
Last updated
11/12/2021
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