# IDAHO PROSTHODONTICS

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

## Provider details

- **NPI number:** 1275736522
- **Authorized official:** DR. DARREL L MOONEY D.D.S., F.A.C.P. (OWNER)
- **Authorized official phone:** (208) 336-9333

## Contact information

- **Practice address:** 347 CROOKED EAR CT, SANDPOINT, ID 83864-9477
- **Practice address phone:** (208) 336-9333
- **Practice address fax:** (208) 387-1951
- **Mailing address:** 301 S DIVISION AVE, SANDPOINT, ID 83864-2737
- **Mailing address phone:** (208) 263-6393
- **Mailing address fax:** (208) 263-6786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0700X | Prosthodontics | D1650 | ID | Yes |

## Other

- **Enumeration date:** 06/06/2007
- **Last updated:** 08/22/2020