| Wyoming Oral & Maxillofacial Surgery P. C. | |
|
4611 Arroyo Dr Suite 1 Casper WY 82604 | |
| (307) 235-1600 | |
| (307) 235-1601 |
| Full Name | Wyoming Oral & Maxillofacial Surgery P. C. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4611 Arroyo Dr Suite 1, Casper, Wyoming |
| Authorized Official Name and Position | Lucas A Hardy (OWNER) |
| Authorized Official Contact | 3072351600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyoming Oral & Maxillofacial Surgery P. C. 4611 Arroyo Dr Suite 1 Casper WY 82604 Ph: (307) 235-1600 | Wyoming Oral & Maxillofacial Surgery P. C. 4611 Arroyo Dr Suite 1 Casper WY 82604 Ph: (307) 235-1600 |
| NPI Number | 1356630057 |
|---|---|
| Provider Enumeration Date | 04/04/2011 |
| Last Update Date | 04/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356630057 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1146 (Wyoming) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 1265 (Wyoming) | Secondary |
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