NPIMap

Organization Active NPI

Casper Mountain Dental

  • General Practice Dentistry
  • Glenrock, WY
National Provider Identifier
1922470293
Registry record updated Oct 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1278 Issued in WY
Legal business name
CASPER MOUNTAIN DENTAL
Practice address
925 W Birch Street
Glenrock, WY 82637
Phone
(307) 436-8770
Fax
(307) 436-8771
NPI assigned
Oct 27, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2015

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

Authorized official

Name
Aaron D Larsen, DDSNPI 1033407531
Title
Owner
Phone
(307) 436-8770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 1278 WY Primary

Addresses

Primary practice location

925 W Birch Street
Glenrock, WY 82637

Mailing address

PO Box 2320
Glenrock, WY 82637-2320
Phone (307) 436-8770

Other identifiers 1

IdentifierTypeStateIssuer
131751200MedicaidWY

Other names 1

  • Glenrock Family Dental Doing business as

National Provider Directory

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

Other organizations with this tax ID 1

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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": "1445904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445904000000",
    "number": "1922470293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2320",
            "city": "GLENROCK",
            "state": "WY",
            "postal_code": "826372320",
            "telephone_number": "307-436-8770",
            "fax_number": "307-436-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 W BIRCH STREET",
            "city": "GLENROCK",
            "state": "WY",
            "postal_code": "82637",
            "telephone_number": "307-436-8770",
            "fax_number": "307-436-8771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASPER MOUNTAIN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-27",
        "last_updated": "2015-10-27",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "AARON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-436-8770",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WY",
            "license": "1278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131751200",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenrock Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenrock, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; 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.