Provider Demographics
NPI:1518185099
Name:ASPEN RIDGE DENTAL
Entity Type:Organization
Organization Name:ASPEN RIDGE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-234-6054
Mailing Address - Street 1:1122 S CONWELL ST.
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WA
Mailing Address - Zip Code:82601-3965
Mailing Address - Country:US
Mailing Address - Phone:307-234-6054
Mailing Address - Fax:307-234-7896
Practice Address - Street 1:1122 S CONWELL ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3965
Practice Address - Country:US
Practice Address - Phone:307-234-6054
Practice Address - Fax:307-234-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty