# COEUR D ALENE FAMILY DENTISRTY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144640509
- **Authorized official:** MR. TYLER SCOFIELD MORTON (CONSULTANT)
- **Authorized official phone:** (208) 626-2625

## Contact information

- **Practice address:** 2201 N GOVERNMENT WAY, SUITE G, COEUR D ALENE, ID 83814-3658
- **Practice address phone:** (208) 664-9129
- **Practice address fax:** (208) 664-9120
- **Mailing address:** 2201 N GOVERNMENT WAY, SUITE G, COEUR D ALENE, ID 83814-3658
- **Mailing address phone:** (208) 664-9129
- **Mailing address fax:** (208) 664-9120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4087 | ID | Yes |

## Other

- **Enumeration date:** 04/23/2014
- **Last updated:** 04/23/2014