| Teton Oral And Maxillofacial Surgery | |
|
1160 Alpine Ln Ste 1d Jackson WY 83001 | |
| (307) 739-8611 | |
| (307) 739-8613 |
| Full Name | Teton Oral And Maxillofacial Surgery |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 1160 Alpine Ln Ste 1d, Jackson, Wyoming |
| Authorized Official Name and Position | Bridget Anne Mullen (OFFICE MANAGER) |
| Authorized Official Contact | 3076901513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teton Oral And Maxillofacial Surgery Po Box 9339 Jackson WY 83002-9339 Ph: (307) 739-8611 | Teton Oral And Maxillofacial Surgery 1160 Alpine Ln Ste 1d Jackson WY 83001 Ph: (307) 739-8611 |
| NPI Number | 1740776202 |
|---|---|
| Provider Enumeration Date | 07/09/2018 |
| Last Update Date | 07/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740776202 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
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