DENTAL CARE OF JACKSON HOLE LLC NPI 1063539963

NPI Information

DENTAL CARE OF JACKSON HOLE, LLC is a general practice dentist in Jackson, WY. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DENTAL CARE OF JACKSON HOLE, LLC NPI is 1063539963. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Joshua G. Wagner Dds Pc.

The provider's business location address is:

610 WEST BROADWAY
CENTENNIAL BUILDING
JACKSON, WY
ZIP 83002
Phone: (307) 732-2273
Fax: (307) 732-1660

The provider's authorized official is Erika Layton Bossi .
The authorized official title is Patient Coordinator and has the following contact phone number (307) 732-2273.

The enumeration date for this NPI number is 3/23/2007 and was last updated on 6/1/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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