Provider Demographics
NPI:1992141527
Name:WIND CITY DENTAL
Entity type:Organization
Organization Name:WIND CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:WARING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-265-9463
Mailing Address - Street 1:1530 CENTENNIAL COURT
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609
Mailing Address - Country:US
Mailing Address - Phone:307-265-9463
Mailing Address - Fax:307-265-3447
Practice Address - Street 1:1530 CENTENNIAL COURT
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:US
Practice Address - Phone:307-265-9463
Practice Address - Fax:307-265-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty