| 2nd Street Dental, Llc | |
|
2546 E 2nd St Ste 300 Casper WY 82609-2062 | |
| (307) 337-3717 | |
| Not Available |
| Full Name | 2nd Street Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2546 E 2nd St Ste 300, Casper, Wyoming |
| Authorized Official Name and Position | Miranda Ann Haefele (DENTIST/OWNER) |
| Authorized Official Contact | 3073373717 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 2nd Street Dental, Llc 2546 E 2nd St Ste 300 Casper WY 82609-2062 Ph: (307) 337-3717 | 2nd Street Dental, Llc 2546 E 2nd St Ste 300 Casper WY 82609-2062 Ph: (307) 337-3717 |
| NPI Number | 1881194280 |
|---|---|
| Provider Enumeration Date | 02/13/2018 |
| Last Update Date | 02/13/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881194280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1316 (Wyoming) | Primary |
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