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CASPER MOUNTAIN DENTAL NPI 1922470293


NPI Information

NPI: 1922470293
Provider Name: CASPER MOUNTAIN DENTAL

Doing Business As: GLENROCK FAMILY DENTAL

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

CLIA Number: 53D0520026

Address:
925 W BIRCH STREET
GLENROCK, WY
ZIP 82637
Phone: (307) 436-8770
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CASPER MOUNTAIN DENTAL is a general practice dentist in Glenrock, 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. CASPER MOUNTAIN DENTAL NPI is 1922470293. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Glenrock Family Dental.

The provider's business location address is:

925 W BIRCH STREET
GLENROCK, WY
ZIP 82637
Phone: (307) 436-8770
Fax: (307) 436-8771

The provider's authorized official is Aaron D Larsen .
The authorized official title is Owner and has the following contact phone number (307) 436-8770.

The CLIA number assigned to this NPI record is 53D0520026 - community clinic with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 10/27/2015 and was last updated on 10/27/2015.


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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice1278WYOMINGYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1131751200MEDICAIDWYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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