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Organization
NORTH COLLEGE DENTAL, PC
Active
Organization
NORTH COLLEGE DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARNI PETERSON (OFFICE MANAGER)
(208) 734-2300
Entity
Organization
Contact information
Practice address
1411 FILLMORE ST, SUITE 601, TWIN FALLS, ID 83301-3343
(208) 734-2300
(208) 736-7214
Mailing address
1411 FILLMORE ST, SUITE 601, TWIN FALLS, ID 83301-3343
(208) 734-2300
(208) 736-7214
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1788
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9201590
IDAHO SMILES
ID
Enumeration date
04/17/2008
Last updated
04/17/2008
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