Provider Demographics
NPI:1881557072
Name:SOUTHERN WYOMING PERIODONTICS LLC
Entity type:Organization
Organization Name:SOUTHERN WYOMING PERIODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:307-423-0325
Mailing Address - Street 1:7010 YELLOWTAIL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-6113
Mailing Address - Country:US
Mailing Address - Phone:307-423-0325
Mailing Address - Fax:307-241-5357
Practice Address - Street 1:7010 YELLOWTAIL RD STE 200
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-6113
Practice Address - Country:US
Practice Address - Phone:307-423-0325
Practice Address - Fax:307-241-5357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN COLORADO PERIODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty