Provider Demographics
NPI:1609202118
Name:TEETH R US
Entity Type:Organization
Organization Name:TEETH R US
Other - Org Name:DR. STEVE JOHNSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-577-0577
Mailing Address - Street 1:1347 S BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4133
Mailing Address - Country:US
Mailing Address - Phone:307-577-0577
Mailing Address - Fax:307-234-4655
Practice Address - Street 1:1347 S BEVERLY ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4133
Practice Address - Country:US
Practice Address - Phone:307-577-0577
Practice Address - Fax:307-234-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty