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General NPI Number Information
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NPI Number | 1780784942
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Entity Type | Organization
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Legal Business Name | DENTAL CARE CENTER PC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 708 W 8TH ST
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City | GILLETTE
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State | WY
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Zip | 82716-4109
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Country | US
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Telephone | 307-682-0233
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Fax | 307-682-5986
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Provider Business Mailing Address
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Address Line | 708 W 8TH ST
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City | GILLETTE
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State | WY
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Zip | 82716-4109
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Country | US
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Telephone | 307-682-0233
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Fax | 307-682-5986
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | NEKTARIOS A BOUZIS
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Credential | D.D.S.
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Telephone | 307-682-0233
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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 | 936
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License Number State | WY
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