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General NPI Number Information
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NPI Number | 1619433174
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Entity Type | Organization
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Legal Business Name | ALBANY COUNTY FAMILY DENTISTRY
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 1156 N 22ND ST STE A
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City | LARAMIE
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State | WY
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Zip | 82072-5403
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Country | US
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Telephone | 307-755-0444
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1150
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City | LARAMIE
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State | WY
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Zip | 82073
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Country | US
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Telephone | 307-755-0444
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Fax | 307-755-0808
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. BYRON W KILLPACK
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Credential | DR
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Telephone | 307-755-0444
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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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