Healthcare Provider Details

I. General information

NPI: 1477849289
Provider Name (Legal Business Name): COLTON J CRANE DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 W SUNSET DR
RIVERTON WY
82501-2353
US

IV. Provider business mailing address

831 W SUNSET DR
RIVERTON WY
82501-2353
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-2778
  • Fax: 307-856-6572
Mailing address:
  • Phone: 307-856-2778
  • Fax: 307-856-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: COLTON JAMES CRANE
Title or Position: OWNER
Credential:
Phone: 307-856-2778