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Organization
CLUB 32 DENTAL
Active
Organization
CLUB 32 DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM BENSON KELLER DDS (OWNER)
(208) 505-8586
Entity
Organization
Contact information
Practice address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 466-2456
(208) 318-0227
Mailing address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 505-8586
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/05/2020
Last updated
02/24/2022
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