Provider Demographics
NPI:1629483813
Name:ROCKY MOUNTAIN FAMILY DENTAL
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LACI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:RECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,PC
Authorized Official - Phone:307-587-5588
Mailing Address - Street 1:956 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3602
Mailing Address - Country:US
Mailing Address - Phone:307-587-5588
Mailing Address - Fax:307-587-7123
Practice Address - Street 1:956 12TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3602
Practice Address - Country:US
Practice Address - Phone:307-587-5588
Practice Address - Fax:307-587-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1384122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty