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General NPI Number Information
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NPI Number | 1942430640
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Entity Type | Organization
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Legal Business Name | WYOMING DENTAL IMAGING, LLC
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 799 S 2ND ST # B
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City | LANDER
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State | WY
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Zip | 82520-3703
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Country | US
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Telephone | 307-332-9136
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Fax | 307-335-8458
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Provider Business Mailing Address
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Address Line | PO BOX 1532
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City | LANDER
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State | WY
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Zip | 82520-1532
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Country | US
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Telephone | 307-332-9136
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Fax | 307-335-8458
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Authorized Official
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Title or Position | OWNER
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Name | BRENT G BILLS
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Credential | DMD, MS
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Telephone | 307-332-9136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 740
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License Number State | WY
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