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General NPI Number Information
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NPI Number | 1093300063
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Entity Type | Organization
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Legal Business Name | MEYER AND DANA ORTHODONTICS GILLETTE, PLLC
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 2670 OAKCREST DR
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City | GILLETTE
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State | WY
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Zip | 82718-5905
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Country | US
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Telephone | 307-257-8029
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 JACKSON BLVD STE A
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City | RAPID CITY
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State | SD
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Zip | 57702-3478
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Country | US
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Telephone | 605-646-0034
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF ADMINISTRATION
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Name | ISAAC A JAHN
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Credential | MPA
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Telephone | 605-343-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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