Individual
EVERETT MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
295 N WALSH DR, CASPER, WY 82609-1911
(307) 265-7878
Mailing address
3361 E 18TH ST, CASPER, WY 82609-3513
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7089
NE
1223P0221X
Pediatric Dentistry
Primary
1343
WY
390200000X
Student in an Organized Health Care Education/Training Program
7089
NE
Other
Enumeration date
07/01/2013
Last updated
01/25/2016
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