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Organization
GRIN PLLC
Active
Organization
GRIN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES G DRAKE DMD (DOCTOR/PARTNER)
(208) 524-0870
Entity
Organization
Contact information
Practice address
2685 CHANNING WAY, IDAHO FALLS, ID 83404-7518
(208) 522-1164
Mailing address
885 PANCHERI DR, IDAHO FALLS, ID 83402-3344
(208) 524-0870
(208) 524-0873
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D1989
ID
1223G0001X
General Practice Dentistry
D3203
ID
1223G0001X
General Practice Dentistry
Primary
D3723
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000886878
UNITED CONCORDIA
—
01
—
001493204
UNITED CONCORDIA
—
01
—
6C016
BLUE CROSS OF IDAHO
ID
01
—
6K158
BLUE CROSS OF IDAHO
ID
Enumeration date
02/16/2018
Last updated
02/16/2018
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