| Star Valley Oral Surgery | |
|
487 N Main Suite B Thayne WY 83127 | |
| (307) 883-4222 | |
| (307) 883-4222 |
| Full Name | Star Valley Oral Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 487 N Main, Thayne, Wyoming |
| Authorized Official Name and Position | Mark Weston Johnson (PRESIDENT) |
| Authorized Official Contact | 3078834222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Star Valley Oral Surgery Po Box 1365 Thayne WY 83127-1365 Ph: (307) 883-4222 | Star Valley Oral Surgery 487 N Main Suite B Thayne WY 83127 Ph: (307) 883-4222 |
| NPI Number | 1821610957 |
|---|---|
| Provider Enumeration Date | 05/12/2020 |
| Last Update Date | 05/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821610957 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Mark W Johnson, Dmd, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 487 N Main St Ste B, Thayne, WY 83127 Phone: 307-883-4222 |