# AVONDALE DENTAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AVONDALE DENTAL CENTER LLC DBA ELEMENT
- **Other names:** Element Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558887067
- **Legal business name:** AVONDALE DENTAL CENTER LLC DBA ELEMENT
- **Authorized official:** MR. JAMES ROBSON DDS (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (208) 772-4066

## Contact information

- **Practice address:** 700 IRONWOOD DR, \#366, COEUR D'ALENE, ID 83814
- **Practice address phone:** (208) 664-2160
- **Practice address fax:** (208) 930-4085
- **Mailing address:** 700 IRONWOOD DR, \#366, COEUR D'ALENE, ID 83814
- **Mailing address phone:** (208) 664-2160
- **Mailing address fax:** (208) 930-4085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-4015 | ID | Yes |

## Other

- **Enumeration date:** 08/16/2017
- **Last updated:** 08/16/2017