Provider Demographics
NPI:1720122773
Name:NEVINS, ZANE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:S
Last Name:NEVINS
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 1:1557 BRICE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3505
Mailing Address - Country:US
Mailing Address - Phone:307-322-4450
Mailing Address - Fax:307-322-1699
Practice Address - Street 1:1557 BRICE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3505
Practice Address - Country:US
Practice Address - Phone:307-322-4450
Practice Address - Fax:307-322-1699
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice