Provider Demographics
NPI:1619434313
Name:CHILDRENS DENTAL CENTER OF ROCK SPRINGS
Entity Type:Organization
Organization Name:CHILDRENS DENTAL CENTER OF ROCK SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:307-362-3395
Mailing Address - Street 1:1208 HILLTOP DR STE 209
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5860
Mailing Address - Country:US
Mailing Address - Phone:586-719-2341
Mailing Address - Fax:
Practice Address - Street 1:1208 HILLTOP DR STE 209
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5860
Practice Address - Country:US
Practice Address - Phone:307-362-3395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY13364583975Medicaid