Organization
2ND STREET DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRANDA ANN HAEFELE DDS (DENTIST/OWNER)
(307) 337-3717
Entity
Organization
Contact information
Practice address
2546 E 2ND ST STE 300, CASPER, WY 82609-2062
(307) 337-3717
Mailing address
2546 E 2ND ST STE 300, CASPER, WY 82609-2062
(307) 337-3717
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1316
WY
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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