Individual
DR. TATE EZRA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
337 GREYBULL AVE, GREYBULL, WY 82426-2049
(307) 765-4654
Mailing address
337 GREYBULL AVE, GREYBULL, WY 82426-2049
(307) 765-4654
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1535
WY
Other
Enumeration date
06/23/2019
Last updated
06/23/2019
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