NPI: 1063539963 · JACKSON, WY 83001 · General Practice Dentistry · NPI assigned 03/23/2007
| Authorized Official | RIDGEWAY, PAULA (MANAGING PARTNER) |
| NPI Enumeration Date | 03/23/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2023 | 26 | $912.60 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 26 | 26 | $912.60 |