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Organization
KENT J ALLEN/ SHANNON WIDMIER
Active
Organization
KENT J ALLEN/ SHANNON WIDMIER
Active
Other names
PHEASANT COVE DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT J ALLEN D.D.S. (OWNER)
(208) 423-6444
Entity
Organization
Contact information
Practice address
702 CENTER ST W, KIMBERLY, ID 83341
(208) 423-6444
(208) 423-6903
Mailing address
702 CENTER STREET WEST, PO BOX B, KIMBERLY, ID 83341
(208) 423-6444
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1767
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000876700
—
ID
01
—
9201818
SMILES
ID
Enumeration date
01/14/2008
Last updated
01/14/2008
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