# SOUTHERN SPRINGS DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730348236
- **Authorized official:** DR. BARRY W JARDINE DMD (OWNER DENTIST)
- **Authorized official phone:** (208) 888-3540

## Contact information

- **Practice address:** 1910 S MERIDIAN RD, STE 150, MERIDIAN, ID 83642-9061
- **Practice address phone:** (208) 888-3540
- **Mailing address:** 1910 S MERIDIAN RD, STE 150, MERIDIAN, ID 83642
- **Mailing address phone:** (208) 888-3540

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3807 | ID | Yes |

## Other

- **Enumeration date:** 06/09/2008
- **Last updated:** 06/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807969400 | — | ID |