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Organization
THE FAMILY DENTAL CENTER, PLLC
Active
Organization
THE FAMILY DENTAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN J. PRUETT (OFFICE MANAGER)
(208) 785-2685
Entity
Organization
Contact information
Practice address
625 W BRIDGE ST, BLACKFOOT, ID 83221-2018
(208) 785-2685
(208) 785-0998
Mailing address
PO BOX 458, BLACKFOOT, ID 83221-0458
(208) 785-2685
(208) 785-0998
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3613
ID
Other
Enumeration date
07/16/2006
Last updated
08/22/2020
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