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Organization
IDAHO SLEEP AND WELLNESS LLC
Active
Organization
IDAHO SLEEP AND WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW L KOOYMAN DDS (OWNER)
(208) 899-2384
Entity
Organization
Contact information
Practice address
1500 W CAYUSE CREEK DR STE 100, MERIDIAN, ID 83646-4757
(208) 899-2384
Mailing address
1500 W CAYUSE CREEK DR STE 100, MERIDIAN, ID 83646-4757
(208) 888-9252
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D-3565
ID
332BC3200X
Customized Equipment (DME)
Primary
D-3565
ID
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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