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Organization
BLACK CANYON DENTAL P C
Active
Organization
BLACK CANYON DENTAL P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHON D ROOKS D.D.S. (PRESIDENT)
(208) 365-3860
Entity
Organization
Contact information
Practice address
1110 S WASHINGTON AVE, EMMETT, ID 83617-3535
(208) 365-3860
Mailing address
1110 S WASHINGTON AVE, EMMETT, ID 83617-3535
(208) 365-3860
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/03/2008
Last updated
06/05/2008
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