Provider Demographics
NPI:1417074261
Name:DENTAL CARE OF JACKSON HOLE, LLC
Entity Type:Organization
Organization Name:DENTAL CARE OF JACKSON HOLE, LLC
Other - Org Name:DENTAL CARE OF ALPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHBAND-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-654-2273
Mailing Address - Street 1:PO BOX 3469
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:WY
Mailing Address - Zip Code:83128-0469
Mailing Address - Country:US
Mailing Address - Phone:307-654-2273
Mailing Address - Fax:
Practice Address - Street 1:363 DEER LANE
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:WY
Practice Address - Zip Code:83128
Practice Address - Country:US
Practice Address - Phone:307-654-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty