Provider Demographics
NPI:1124708896
Name:307 DENTAL STUDIO LLC
Entity type:Organization
Organization Name:307 DENTAL STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:P
Authorized Official - Last Name:RINKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-480-9009
Mailing Address - Street 1:3401 CRIBBON AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1076
Mailing Address - Country:US
Mailing Address - Phone:702-480-9009
Mailing Address - Fax:
Practice Address - Street 1:2100 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3608
Practice Address - Country:US
Practice Address - Phone:702-480-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental