| Dental Care Of Jackson Hole, Llc | |
|
610 West Broadway Centennial Building Jackson WY 83002 | |
| (307) 732-2273 | |
| (307) 732-1660 |
| Full Name | Dental Care Of Jackson Hole, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 610 West Broadway, Jackson, Wyoming |
| Authorized Official Name and Position | Erika Layton Bossi (PATIENT COORDINATOR) |
| Authorized Official Contact | 3077322273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Care Of Jackson Hole, Llc P.o. Box 9340 Jackson WY 83002 Ph: (307) 732-2273 | Dental Care Of Jackson Hole, Llc 610 West Broadway Centennial Building Jackson WY 83002 Ph: (307) 732-2273 |
| NPI Number | 1063539963 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 06/01/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063539963 | NPI | - | NPPES |
| 119801700 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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