2nd Street Dental, LLC

NPI #1881194280 in Casper, Wyoming

Provider Information

NPI Number: 1881194280
Entity Type: Organization
Organization Name: 2nd Street Dental, LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Feb 13, 2018
Last Updated: Feb 13, 2018

Practice Location

Address: 2546 E 2ND ST STE 300
City: Casper
State: Wyoming
ZIP Code: 82609-2062
Phone: (307) 337-3717

Authorized Official

Name: DR. MIRANDA ANN HAEFELE, DDS
Title: DENTIST/OWNER
Phone: (307) 337-3717

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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