# POTLATCH FAMILY DENTAL, PC

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

## Provider details

- **NPI number:** 1245515832
- **Authorized official:** DR. AMMON MICHAEL PITT D.D.S. (DENTIST)
- **Authorized official phone:** (208) 875-0441

## Contact information

- **Practice address:** 225 6TH STREET, POTLATCH, ID 83855
- **Practice address phone:** (208) 875-0441
- **Practice address fax:** (208) 875-0972
- **Mailing address:** PO BOX 601, POTLATCH, ID 83855-0601
- **Mailing address phone:** (208) 875-0441
- **Mailing address fax:** (208) 875-0972

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3984 | ID | Yes |

## Other

- **Enumeration date:** 10/15/2011
- **Last updated:** 10/15/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 8075010 | — | ID |