Provider Demographics
NPI:1265596084
Name:MCPHERSON, JOHN RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:MCPHERSON
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 1:1408 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2271
Mailing Address - Country:US
Mailing Address - Phone:307-745-8170
Mailing Address - Fax:307-742-0543
Practice Address - Street 1:204 MCCOLLUM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5103
Practice Address - Country:US
Practice Address - Phone:307-742-2328
Practice Address - Fax:307-742-0543
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY 1100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist