| Glenrock Family Dental | |
|
925 W Birch Street Glenrock WY 82637 | |
| (307) 436-8770 | |
| (307) 436-8771 |
| Full Name | Glenrock Family Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 925 W Birch Street, Glenrock, Wyoming |
| Authorized Official Name and Position | Aaron D Larsen (OWNER) |
| Authorized Official Contact | 3074368770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenrock Family Dental Po Box 2320 Glenrock WY 82637-2320 Ph: (307) 436-8770 | Glenrock Family Dental 925 W Birch Street Glenrock WY 82637 Ph: (307) 436-8770 |
| NPI Number | 1922470293 |
|---|---|
| Provider Enumeration Date | 10/27/2015 |
| Last Update Date | 10/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922470293 | NPI | - | NPPES |
| 131751200 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1278 (Wyoming) | Primary |