Provider Demographics
NPI:1518330141
Name:LARAME DENTAL ARTS, PC
Entity Type:Organization
Organization Name:LARAME DENTAL ARTS, PC
Other - Org Name:LARAMIE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-742-8484
Mailing Address - Street 1:3529 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5135
Mailing Address - Country:US
Mailing Address - Phone:307-742-8484
Mailing Address - Fax:307-742-9426
Practice Address - Street 1:3529 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5135
Practice Address - Country:US
Practice Address - Phone:307-742-8484
Practice Address - Fax:307-742-9426
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARAMIE DENTAL ARTS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty