# EAGLE DENTAL PARTNERSHIP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ascend Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639732399
- **Authorized official:** MRS. LEAH M. GARDOSKI (INSURANCE ADMINISTRATOR)
- **Authorized official phone:** (208) 939-3500

## Contact information

- **Practice address:** 577 E STATE ST, EAGLE, ID 83616-5938
- **Practice address phone:** (208) 939-3500
- **Practice address fax:** (208) 939-3837
- **Mailing address:** 577 E STATE ST, EAGLE, ID 83616-5938
- **Mailing address phone:** (208) 939-3500
- **Mailing address fax:** (208) 939-3837

## Taxonomy

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

## Other

- **Enumeration date:** 04/18/2019
- **Last updated:** 08/11/2025