| Elkridge Dental South Llc | |
|
1315 S Hwy 89 Jackson WY 83001-8514 | |
| (307) 733-4122 | |
| Not Available |
| Full Name | Elkridge Dental South Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1315 S Hwy 89, Jackson, Wyoming |
| Authorized Official Name and Position | Nathan Tanner (PRESIDENT) |
| Authorized Official Contact | 5038668454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elkridge Dental South Llc Po Box 1190 Jackson WY 83001-1190 Ph: (307) 733-2555 | Elkridge Dental South Llc 1315 S Hwy 89 Jackson WY 83001-8514 Ph: (307) 733-4122 |
| NPI Number | 1538822374 |
|---|---|
| Provider Enumeration Date | 10/19/2021 |
| Last Update Date | 10/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538822374 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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