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General NPI Number Information
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NPI Number | 1629483813
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN FAMILY DENTAL
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 956 12TH ST
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City | CODY
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State | WY
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Zip | 82414-3602
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Country | US
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Telephone | 307-587-5588
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Fax | 307-587-7123
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Provider Business Mailing Address
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Address Line | 956 12TH ST
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City | CODY
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State | WY
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Zip | 82414-3602
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Country | US
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Telephone | 307-587-5588
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Fax | 307-587-7123
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LACI DAWN RECTOR
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Credential | DDS,PC
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Telephone | 307-587-5588
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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 | 1384
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License Number State | WY
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