| Casper Children's Dental Clinic | |
|
102 N. Kenwood St. Casper WY 82601-2724 | |
| (307) 266-1997 | |
| (307) 237-4424 |
| Full Name | Casper Children's Dental Clinic |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 102 N. Kenwood St., Casper, Wyoming |
| Authorized Official Name and Position | Roy Edward Paulson (PEDIATRIC DENTIST) |
| Authorized Official Contact | 3072661997 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Casper Children's Dental Clinic 102 N. Kenwood St. Casper WY 82601-2724 Ph: (307) 266-1997 | Casper Children's Dental Clinic 102 N. Kenwood St. Casper WY 82601-2724 Ph: (307) 266-1997 |
| NPI Number | 1750584173 |
|---|---|
| Provider Enumeration Date | 06/06/2007 |
| Last Update Date | 03/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750584173 | NPI | - | NPPES |
| 112331900 | Medicaid | WY | |
| A0H1301FUMCMEAT | Other | CMS EHR CERTIFICATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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