Provider Demographics
NPI:1942493077
Name:DR. DAVID KRISE DDS,LLC
Entity Type:Organization
Organization Name:DR. DAVID KRISE DDS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-349-3308
Mailing Address - Street 1:799 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3703
Mailing Address - Country:US
Mailing Address - Phone:307-349-3308
Mailing Address - Fax:307-335-8215
Practice Address - Street 1:799 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3703
Practice Address - Country:US
Practice Address - Phone:307-349-3308
Practice Address - Fax:307-335-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty