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Organization
COUCH DENTAL CARE
Active
Organization
COUCH DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VAL ALETA SWENSON (CLINICAL MANAGER)
(208) 552-5520
Entity
Organization
Contact information
Practice address
2110 E 25TH ST, IDAHO FALLS, ID 83404-6475
(208) 552-5520
(208) 552-5522
Mailing address
2110 E 25TH ST, IDAHO FALLS, ID 83404-6475
(208) 552-5520
(208) 552-5522
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D1303
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D1303
STATE LICENSE
ID
Enumeration date
10/09/2013
Last updated
10/09/2013
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