Provider Demographics
NPI:1144769597
Name:DENTURES & DENTAL CARE OF LANDER, LLC
Entity Type:Organization
Organization Name:DENTURES & DENTAL CARE OF LANDER, LLC
Other - Org Name:LANDER FAMILY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-332-3434
Mailing Address - Street 1:933 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3041
Mailing Address - Country:US
Mailing Address - Phone:307-332-3434
Mailing Address - Fax:307-332-5955
Practice Address - Street 1:933 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3041
Practice Address - Country:US
Practice Address - Phone:307-332-3434
Practice Address - Fax:307-332-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty