# GREEN ACRES DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Green Acres Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013672617
- **Authorized official:** FAITH GASKINS (DIRECTOR OF CREDENTIAL)
- **Authorized official phone:** (972) 869-3789

## Contact information

- **Practice address:** 871 GREEN ACRES DR, TWIN FALLS, ID 83301-3353
- **Practice address phone:** (208) 733-4620
- **Mailing address:** 871 GREEN ACRES DR, TWIN FALLS, ID 83301-3353
- **Mailing address phone:** (208) 733-4620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2021
- **Last updated:** 11/08/2021