Healthcare Provider Details

I. General information

NPI: 1588759179
Provider Name (Legal Business Name): JOHN A BLUHER DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 BECK AVE
CODY WY
82414-3624
US

IV. Provider business mailing address

1120 BECK AVE
CODY WY
82414-3624
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-4151
  • Fax: 307-587-2152
Mailing address:
  • Phone: 307-587-4151
  • Fax: 307-587-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number475
License Number StateWY

VIII. Authorized Official

Name: DR. JOHN ALFRED BLUHER
Title or Position: PRESIDENT
Credential: DDS MS PC
Phone: 307-587-4157