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Organization
CLUB 32 DENTAL CALDWELL PLLC
Active
Organization
CLUB 32 DENTAL CALDWELL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM KELLER DDS (OWNER)
(208) 506-3233
Entity
Organization
Contact information
Practice address
1916 ELLIS AVE, CALDWELL, ID 83605-4811
(208) 466-2456
Mailing address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 506-3233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
03/24/2021
Last updated
03/10/2022
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