# WOODLAND FAMILY DENTAL PC

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

## Provider details

- **NPI number:** 1528431665
- **Authorized official:** DAVID GRAHAM WELTON DDS (CEO)
- **Authorized official phone:** (406) 366-0661

## Contact information

- **Practice address:** 5082 E SHORE CV, POST FALLS, ID 83854-6888
- **Practice address phone:** (406) 366-0661
- **Mailing address:** 1100 E POLSTON AVE, POST FALLS, ID 83854-6045
- **Mailing address phone:** (406) 366-0661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4714 | ID | — |
| 1223G0001X | General Practice Dentistry | D4715 | ID | Yes |

## Other

- **Enumeration date:** 11/12/2015
- **Last updated:** 11/12/2015