Organization
KINCHELOE DENTAL OFFICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY B KINCHELOE DDS (OFFICER)
(307) 638-8520
Entity
Organization
Contact information
Practice address
6244 YELLOWSTONE RD, CHEYENNE, WY 82009-3432
(307) 638-8520
Mailing address
2625 WILDHORSE TRL, CHEYENNE, WY 82009-2232
(307) 638-6544
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1070
WY
Other
Enumeration date
03/23/2007
Last updated
08/22/2020
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