# KSS DENTAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KSS DENTAL GROUP PLLC
- **Other names:** Fairview Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457704009
- **Legal business name:** KSS DENTAL GROUP PLLC
- **Authorized official:** DR. KEITH L STUCKI DMD (MANAGER)
- **Authorized official phone:** (208) 459-3388

## Contact information

- **Practice address:** 329 E LOGAN ST, CALDWELL, ID 83605-4863
- **Practice address phone:** (208) 459-3388
- **Practice address fax:** (208) 453-9295
- **Mailing address:** 329 E LOGAN ST, CALDWELL, ID 83605-4863
- **Mailing address phone:** (208) 459-3388
- **Mailing address fax:** (208) 453-9295

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3315 | ID | Yes |

## Other

- **Enumeration date:** 07/19/2016
- **Last updated:** 07/19/2016