Healthcare Provider Details

I. General information

NPI: 1093300063
Provider Name (Legal Business Name): MEYER AND DANA ORTHODONTICS GILLETTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 OAKCREST DR
GILLETTE WY
82718-5905
US

IV. Provider business mailing address

2620 JACKSON BLVD STE A
RAPID CITY SD
57702-3478
US

V. Phone/Fax

Practice location:
  • Phone: 307-257-8029
  • Fax:
Mailing address:
  • Phone: 605-646-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISAAC A JAHN
Title or Position: DIRECTOR OF ADMINISTRATION
Credential: MPA
Phone: 605-343-1500