Provider Demographics
NPI:1891127825
Name:BIGHORN DENTAL CLINIC PC
Entity type:Organization
Organization Name:BIGHORN DENTAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-686-1567
Mailing Address - Street 1:4403 RUNNING W. DRIVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718
Mailing Address - Country:US
Mailing Address - Phone:307-686-1567
Mailing Address - Fax:307-686-2805
Practice Address - Street 1:4403 RUNNING W. DRIVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-686-1567
Practice Address - Fax:307-686-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1345122300000X, 122300000X
WY1175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty