Provider Demographics
NPI:1871666164
Name:LIVINGSTON, JAMES GARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GARRY
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SOUTH WASHINGTON ST.
Mailing Address - Street 2:800 SOUTH WASHINGTON STREET
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110
Mailing Address - Country:US
Mailing Address - Phone:307-885-4337
Mailing Address - Fax:307-885-4334
Practice Address - Street 1:800 SOUTH WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-1709
Practice Address - Country:US
Practice Address - Phone:307-885-4337
Practice Address - Fax:307-885-4334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112487100Medicaid