# IDAHO DENTAL PROFESSIONALS, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IDAHO DENTAL PROFESSIONALS, P.C.
- **Other names:** White Pine Dental Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1376304451
- **Legal business name:** IDAHO DENTAL PROFESSIONALS, P.C.
- **Authorized official:** CEMYIRA MCDOUGAL (CREDENTIALING)
- **Authorized official phone:** (217) 764-8609

## Contact information

- **Practice address:** 283 S TEN MILE RD, MERIDIAN, ID 83642-6105
- **Practice address phone:** (208) 639-1017
- **Practice address fax:** (208) 639-1069
- **Mailing address:** 283 S TEN MILE RD, MERIDIAN, ID 83642-6105
- **Mailing address phone:** (208) 639-1017
- **Mailing address fax:** (208) 639-1069

## Taxonomy

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

## Other

- **Enumeration date:** 01/17/2024
- **Last updated:** 01/17/2024