NPI: 1205291242 · KEMMERER, WY 83101 · General Practice Dentistry · NPI assigned 12/17/2015
| Authorized Official | GRANDY, STEPHEN (PRESIDENT) |
| NPI Enumeration Date | 12/17/2015 |
| Year | Claims | Total Paid |
|---|---|---|
| 2019 | 13 | $416.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 13 | 13 | $416.00 |