-- GRANT KOLLENBORN --
Individual Provider (NPI-1)
Active
Dentist, General Practice
Provider Information
- NPI Number
1548678758- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 1315 US-89, SUITE 102, JACKSON, WY, 83001
- Phone
- (307) 733-4122
- Fax
- (307) 733-4164
Specialties & Taxonomies
Dentist, General Practice
Primary License: LA #6488