| Diamond G Dental | |
|
1702 Antelope Street Kemmerer WY 83101-4049 | |
| (307) 877-4715 | |
| Not Available |
| Full Name | Diamond G Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1702 Antelope Street, Kemmerer, Wyoming |
| Authorized Official Name and Position | Stephen Brad Grandy (PRESIDENT) |
| Authorized Official Contact | 3077230448 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond G Dental 1806 Antelope St Apt D Kemmerer WY 83101-4049 Ph: (307) 877-4715 | Diamond G Dental 1702 Antelope Street Kemmerer WY 83101-4049 Ph: (307) 877-4715 |
| NPI Number | 1205291242 |
|---|---|
| Provider Enumeration Date | 12/17/2015 |
| Last Update Date | 12/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205291242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1386 (Wyoming) | Primary |
Robert P. Tyrrell, D.d.s. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1702 Antelope Street, Kemmerer, WY 83101 Phone: 307-877-4715 Fax: 307-877-3475 |