| Surfin Smiles | |
|
295 N Walsh Dr Casper WY 82609-1911 | |
| (307) 265-7878 | |
| (307) 268-4953 |
| Full Name | Surfin Smiles |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 295 N Walsh Dr, Casper, Wyoming |
| Authorized Official Name and Position | Denise Robin Prugh (OWNER) |
| Authorized Official Contact | 3072657878 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Surfin Smiles 295 N Walsh Dr Casper WY 82609-1911 Ph: (307) 265-7878 | Surfin Smiles 295 N Walsh Dr Casper WY 82609-1911 Ph: (307) 265-7878 |
| NPI Number | 1679952865 |
|---|---|
| Provider Enumeration Date | 05/21/2015 |
| Last Update Date | 05/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679952865 | NPI | - | NPPES |
| 114491000 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | () | Secondary |
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