Clubhouse Pediatric Dentistry Of Jackson | |
1130 Us-89 Jackson Hole WY 83001-8701 | |
(307) 733-5439 | |
Not Available |
Full Name | Clubhouse Pediatric Dentistry Of Jackson |
---|---|
Speciality | Dentist - Pediatric Dentistry |
Location | 1130 Us-89, Jackson Hole, Wyoming |
Authorized Official Name and Position | Courtney Matthew Jackson (PEDIATRIC DENTIST) |
Authorized Official Contact | 3077335439 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Clubhouse Pediatric Dentistry Of Jackson 3210 E 81st S Idaho Falls ID 83406-8302 Ph: (307) 733-5439 | Clubhouse Pediatric Dentistry Of Jackson 1130 Us-89 Jackson Hole WY 83001-8701 Ph: (307) 733-5439 |
NPI Number | 1942775960 |
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Provider Enumeration Date | 10/05/2018 |
Last Update Date | 10/05/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942775960 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
News Archive
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