Organization
CASPER MOUNTAIN DENTAL
Active
Other names
Glenrock Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AARON D LARSEN DDS (OWNER)
(307) 436-8770
Entity
Organization
Contact information
Practice address
925 W BIRCH STREET, GLENROCK, WY 82637
(307) 436-8770
(307) 436-8771
Mailing address
PO BOX 2320, GLENROCK, WY 82637-2320
(307) 436-8770
(307) 436-8771
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1278
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131751200
—
WY
Enumeration date
10/27/2015
Last updated
10/27/2015
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