Healthcare Provider Details

I. General information

NPI: 1770839144
Provider Name (Legal Business Name): DAVID DINGMAN MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 W MARIPOSA PKWY
WHEATLAND WY
82201-3102
US

IV. Provider business mailing address

1954 W MARIPOSA PKWY
WHEATLAND WY
82201-3102
US

V. Phone/Fax

Practice location:
  • Phone: 307-322-3190
  • Fax: 307-322-3198
Mailing address:
  • Phone: 307-322-3190
  • Fax: 307-322-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number589
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: