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General NPI Number Information
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NPI Number | 1518436195
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Entity Type | Organization
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Legal Business Name | SUMMIT VIEW DENTISTRY, P.C.
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 3125 E GRAND AVE UNIT B
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City | LARAMIE
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State | WY
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Zip | 82070-5137
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Country | US
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Telephone | 307-631-9262
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Fax |
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Provider Business Mailing Address
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Address Line | 3125 E GRAND AVE UNIT B
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City | LARAMIE
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State | WY
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Zip | 82070-5137
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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 | DENTIST/OWNER
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Name | STACIE MORRISON
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Credential |
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Telephone | 307-631-9262
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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 |
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License Number State |
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