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General NPI Number Information
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NPI Number | 1629097282
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Entity Type | Organization
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Legal Business Name | REBECCA CLOETTA DDS PC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 1315 S HWY 89 STE 102
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City | JACKSON
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State | WY
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Zip | 83001
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Country | US
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Telephone | 307-733-4122
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Fax | 307-733-4164
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Provider Business Mailing Address
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Address Line | PO BOX 11570
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City | JACKSON
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State | WY
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Zip | 83002-1570
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Country | US
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Telephone | 307-733-4122
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Fax | 307-733-4164
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Authorized Official
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Title or Position | DR.
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Name | DR. REBECCA E CLOETTA
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Credential | DDS
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Telephone | 307-733-4122
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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 | 1009
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License Number State | WY
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