# PATRICK L WAITE DDS, PC

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

## Provider details

- **NPI number:** 1558806315
- **Authorized official:** PATRICK L WAITE DDS (DENTIST)
- **Authorized official phone:** (208) 455-0022

## Contact information

- **Practice address:** 4105 CLOCK TOWER AVE, CALDWELL, ID 83607-5006
- **Practice address phone:** (208) 455-0022
- **Practice address fax:** (208) 455-8535
- **Mailing address:** 4105 CLOCK TOWER AVE, CALDWELL, ID 83607-5006
- **Mailing address phone:** (208) 455-0022
- **Mailing address fax:** (208) 455-8535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3975 | ID | Yes |

## Other

- **Enumeration date:** 01/03/2017
- **Last updated:** 01/03/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9202298 | — | ID |