# THE FAMILY DENTAL CENTER, PLLC

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

## Provider details

- **NPI number:** 1538186366
- **Authorized official:** MS. KAREN J. PRUETT (OFFICE MANAGER)
- **Authorized official phone:** (208) 785-2685

## Contact information

- **Practice address:** 625 W BRIDGE ST, BLACKFOOT, ID 83221-2018
- **Practice address phone:** (208) 785-2685
- **Practice address fax:** (208) 785-0998
- **Mailing address:** PO BOX 458, BLACKFOOT, ID 83221-0458
- **Mailing address phone:** (208) 785-2685
- **Mailing address fax:** (208) 785-0998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3613 | ID | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 08/22/2020