Organization
STAR VALLEY ORAL SURGERY
Active
Organization
STAR VALLEY ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK WESTON JOHNSON DMD (PRESIDENT)
(307) 883-4222
Entity
Organization
Contact information
Practice address
487 N MAIN, SUITE B, THAYNE, WY 83127
(307) 883-4222
(307) 883-4222
Mailing address
PO BOX 1365, THAYNE, WY 83127-1365
(307) 883-4222
(307) 883-4223
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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