Teton Oral & Maxillofacial Surgery

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

TETON ORAL & MAXILLOFACIAL SURGERY

Practice address

1160 Alpine Lane
#1D
Jackson, WY 83002

Phone

(307) 739-8611

Fax

(307) 739-8613

NPI assigned

Aug 4, 2006

Organization subpart

No

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

Authorized official

Name

Michael Stern, DMD PHDNPI 1083852149

Title

President

Phone

(307) 739-8611

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

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

• Michael Stern, D.M.D, PHD

  • Oral and Maxillofacial Surgery (Dentist)
  • Jackson, WY
  • NPI 1083852149
  NPD (past) Authorized official

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532563200000",
    "number": "1164430971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9339",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830029339",
            "telephone_number": "307-739-8611",
            "fax_number": "307-739-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 ALPINE LANE",
            "address_2": "#1D",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83002",
            "telephone_number": "307-739-8611",
            "fax_number": "307-739-8613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2018-07-26",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-739-8611",
        "authorized_official_credential": "DMD PHD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119386400",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teton Dermatology LLC
• Teton Hand Therapy LLC
• Teton Hand Therapy LLC
• Teton Internal Medicine PC
• Teton MRI
• Teton Oral and Maxillofacial Surgery
• Teton Outpatient Services LLC
• Teton Pathology, PC
• Teton Pediatrics PC
• Teton Psychology Clinic, LLC

• Oral & Maxillofacial Surgery (D.M.D.) in Jackson, WY
• Providers in Jackson, WY by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2018; 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.