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Organization

ABC PEDIATRIC DENTISTRY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NATHAN D STEVENSON DDS (MANAGER)
(801) 842-6971
Entity
Organization

Contact information

Practice address
610 S 4J CT # B, GILLETTE, WY 82716-4127
(801) 842-6971
Mailing address
4019 W 12600 S STE 200, RIVERTON, UT 84096-7406
(801) 842-6971

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary

Other

Enumeration date
05/28/2010
Last updated
05/28/2010
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