Individual
GRANT KOLLENBORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1315 US-89, SUITE 102, JACKSON, WY 83001
(307) 733-4122
(307) 733-4164
Mailing address
PO BOX 8888, JACKSON, WY 83002-8888
(307) 690-7377
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6488
LA
Other
Enumeration date
07/31/2014
Last updated
08/07/2026
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