| Organization Name: | MOUNTAIN DENTAL PC |
| NPI Number: | 1366596033 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TODD ROBERT SUTTON (DENTIST) |
| Mailing Address: | 345 Garfield St Lander |
| State: | WY US |
| Postal Code: | 825203123 |
| Phone Number: | 3073325230 |
| Fax Number: | 3073325297 |
| NPI Enumeration Date: | 01/22/2007 |
| NPI Last Update Date: | 06/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 975 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |