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Organization
LEGACY FAMILY DENTAL CARE PLLC
Active
Organization
LEGACY FAMILY DENTAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINE ELAINE GIBBON (OFFICE MANAGER)
(208) 773-1559
Entity
Organization
Contact information
Practice address
801 E MEDICAL CT, POST FALLS, ID 83854-7298
(208) 773-1559
(208) 773-9959
Mailing address
801 E MEDICAL CT, POST FALLS, ID 83854-7298
(208) 773-1559
(208) 773-9959
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4275
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093949133
DENTAL
ID
Enumeration date
03/31/2015
Last updated
11/11/2015
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