| Blacks Fork Dental, Pc | |
|
650 Parkway Dr Mt View WY 82939 | |
| (307) 782-3630 | |
| Not Available |
| Full Name | Blacks Fork Dental, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 650 Parkway Dr, Mt View, Wyoming |
| Authorized Official Name and Position | Nathan Ren Lester (PRESIDENT) |
| Authorized Official Contact | 3077823630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blacks Fork Dental, Pc Po Box 356 Mountain View WY 82939-0356 Ph: (307) 782-3630 | Blacks Fork Dental, Pc 650 Parkway Dr Mt View WY 82939 Ph: (307) 782-3630 |
| NPI Number | 1508322603 |
|---|---|
| Provider Enumeration Date | 02/13/2019 |
| Last Update Date | 02/13/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508322603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |