| Davis Periodontics | |
|
5850 E 2nd St Ste 100 Casper WY 82609-4342 | |
| (307) 472-0207 | |
| (307) 472-0259 |
| Full Name | Davis Periodontics |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 5850 E 2nd St, Casper, Wyoming |
| Authorized Official Name and Position | Michael A Davis (DENTIST) |
| Authorized Official Contact | 3074720207 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Davis Periodontics 5850 E 2nd St Ste 100 Casper WY 82609-4342 Ph: (307) 472-0207 | Davis Periodontics 5850 E 2nd St Ste 100 Casper WY 82609-4342 Ph: (307) 472-0207 |
| NPI Number | 1881950954 |
|---|---|
| Provider Enumeration Date | 04/03/2012 |
| Last Update Date | 04/03/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881950954 | NPI | - | NPPES |
| 1568682011 | Other | WY | INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 1274 (Wyoming) | Primary |
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