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Contact Information

BEAR RIVER DENTAL
50 PARK RD
EVANSTON, WY82930-2613
 Phone: 307-789-5608
 Fax: 307-789-4401
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

Oral and Maxillofacial Surgery

1223S0112X 19 Oral Surgery (Dentist only)
 

Orthodontics and Dentofacial Orthopedics

1223X0400X
Indicates primary specialty

NPI Profile & details for BEAR RIVER DENTAL

NPI Number 1649575465
LBN Legal business name BEAR RIVER DENTAL
Authorized official NATHAN LESTER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/26/2011
Last updated 01/26/2011 - About 15 years ago
Identifiers
WY License # 1131
WY License # 1202
WY License # 1250
WY License # 1257
WY Medicaid 1023268299
WY Medicaid 1063492981
WY Medicaid 1558432120
WY Medicaid 1689795114
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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