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General NPI Number Information
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NPI Number | 1073885224
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Entity Type | Organization
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Legal Business Name | BLACK HILLS DENTAL P.C.
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 17 S SENECA AVE
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City | NEWCASTLE
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State | WY
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Zip | 82701-2816
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Country | US
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Telephone | 307-746-4772
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | NEWCASTLE
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State | WY
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Zip | 82701-0190
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD RATTS
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Credential |
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Telephone | 307-746-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1264
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 724
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License Number State | WY
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