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General NPI Number Information
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NPI Number | 1609202118
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Entity Type | Organization
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Legal Business Name | TEETH R US
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 1347 S BEVERLY ST
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City | CASPER
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State | WY
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Zip | 82609-4133
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Country | US
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Telephone | 307-577-0577
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Fax | 307-234-4655
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Provider Business Mailing Address
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Address Line | 1347 S BEVERLY ST
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City | CASPER
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State | WY
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Zip | 82609-4133
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Country | US
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Telephone | 307-577-0577
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Fax | 307-234-4655
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Authorized Official
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Title or Position | DENTIST
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Name | DR. STEVE JOHNSTON
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Credential | DDS
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Telephone | 307-577-0577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 861
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License Number State | WY
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