Organization
LANDER DENTAL GROUP,PC
Active
Parent organization
LANDER DENTAL GROUP, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LANDER DENTAL GROUP, PC
Authorized official
CHRIS R PETERSON DDS (PRESIDENT)
(307) 332-7710
Entity
Organization
Contact information
Practice address
799 S 2ND ST, LANDER, WY 82520-3703
(307) 332-7710
Mailing address
799 S 2ND ST, LANDER, WY 82520-3703
(307) 332-7710
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118366400
—
WY
Enumeration date
08/16/2007
Last updated
11/20/2014
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