Provider Demographics
NPI:1154426906
Name:WIMPENNY, ROBERT G (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:WIMPENNY
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:PO BOX 840
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0840
Mailing Address - Country:US
Mailing Address - Phone:307-326-5474
Mailing Address - Fax:307-326-5414
Practice Address - Street 1:1212 S RIVER ST
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-0840
Practice Address - Country:US
Practice Address - Phone:307-326-5474
Practice Address - Fax:307-326-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice