| Evanston Dental,llc | |
|
1425 Highway 150 S Evanston WY 82930-5377 | |
| (307) 789-0500 | |
| Not Available |
| Full Name | Evanston Dental,llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1425 Highway 150 S, Evanston, Wyoming |
| Authorized Official Name and Position | Micah Daniel Himmerich (OWNER/MEMBER) |
| Authorized Official Contact | 3077890500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evanston Dental,llc 1425 Highway 150 S Evanston WY 82930-5377 Ph: (307) 789-0500 | Evanston Dental,llc 1425 Highway 150 S Evanston WY 82930-5377 Ph: (307) 789-0500 |
| NPI Number | 1023863768 |
|---|---|
| Provider Enumeration Date | 04/17/2024 |
| Last Update Date | 04/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023863768 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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