Healthcare Provider Details

I. General information

NPI: 1861909939
Provider Name (Legal Business Name): TOFT FAMILY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 E 12TH ST
CASPER WY
82601-4002
US

IV. Provider business mailing address

1555 E 12TH ST
CASPER WY
82601-4002
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-9198
  • Fax: 307-235-3165
Mailing address:
  • Phone: 307-235-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1318
License Number StateWY

VIII. Authorized Official

Name: DR. JENELLE MARIE TOFT
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 307-235-9198