# SUMMIT DENTAL CARE PAUL, PLLC

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

## Provider details

- **NPI number:** 1346789534
- **Authorized official:** ALISA FRAME FAADOM (OFFICE MANAGER)
- **Authorized official phone:** (208) 733-9999

## Contact information

- **Practice address:** 207 W ELLIS STREET, PAUL, ID 83347
- **Practice address phone:** (208) 438-4855
- **Practice address fax:** (208) 438-4835
- **Mailing address:** PO BOX 549, PAUL, ID 83347-0549
- **Mailing address phone:** (208) 438-4855
- **Mailing address fax:** (208) 438-4835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4743 | ID | Yes |

## Other

- **Enumeration date:** 02/21/2017
- **Last updated:** 02/21/2017