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Organization
SOUTHWAY ORTHODONTICS PLLC
Active
Organization
SOUTHWAY ORTHODONTICS PLLC
Active
Other names
Christensen Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRET CHRISTENSEN DDS, MS (DR)
(208) 791-0428
Entity
Organization
Contact information
Practice address
77 SOUTHWAY AVE, SUITE D, LEWISTON, ID 83501-2203
(208) 798-4427
(208) 743-4807
Mailing address
77 SOUTHWAY AVE, SUITE D, LEWISTON, ID 83501-2203
(208) 798-4427
(208) 743-4807
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
D 3069 OR
ID
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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