NPIMap

Organization Active NPI

Casper Mountain Dental Dba Advanced Family Dental

  • General Practice Dentistry
  • Casper, WY
National Provider Identifier
1164147666
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CASPER MOUNTAIN DENTAL DBA ADVANCED FAMILY DENTAL
Practice address
1431 S. Beverly Street
Casper, WY 82609
Phone
(307) 265-5334
Fax
(307) 265-5336
NPI assigned
Oct 6, 2022
Organization subpart
Yes
Parent organization
CASPER MOUNTAIN DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Aaron Larsen, DDS
Title
Owner
Phone
(307) 259-0058

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1431 S. Beverly Street
Casper, WY 82609

Mailing address

1431 S. Beverly Street
Casper, WY 82609
Phone (307) 265-5334

Other identifiers 1

IdentifierTypeStateIssuer
131751200MedicaidWY

Other names 1

  • Casper Mountain Dental dba Glenrock Family Dental Other name

National Provider Directory

National Provider Directory
Tax ID family
Casper Mountain Dental Dba Advanced Family Dental2 organizations share this tax ID, including this one
Part of
Casper Mountain Dental Dba Advanced Family Dental

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1431 S Beverly St
Casper, WY 82609
Phone (307) 265-5334

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1164147666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 S. BEVERLY STREET",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "82609",
            "telephone_number": "307-265-5334",
            "fax_number": "307-265-5336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1431 S. BEVERLY STREET",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "82609",
            "telephone_number": "307-265-5334",
            "fax_number": "307-265-5336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASPER MOUNTAIN DENTAL DBA ADVANCED FAMILY DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASPER MOUNTAIN DENTAL",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-259-0058",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131751200",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Casper Mountain Dental dba Glenrock Family Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Casper, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.