# CHILDRENS DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHILDRENS DENTISTRY OF IDAHO
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790225399
- **Legal business name:** CHILDRENS DENTISTRY OF IDAHO
- **Authorized official:** DR. JEFFREY C BRYSON DDS (OWNER)
- **Authorized official phone:** (208) 467-5100

## Contact information

- **Practice address:** 515 W IDAHO AVE, ONTARIO, OR 97914-2348
- **Practice address phone:** (541) 709-5500
- **Practice address fax:** (208) 467-5199
- **Mailing address:** 515 W IDAHO AVE, ONTARIO, OR 97914-2348
- **Mailing address phone:** (541) 709-5500
- **Mailing address fax:** (208) 467-5199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | D10349 | OR | Yes |

## Other

- **Enumeration date:** 03/01/2017
- **Last updated:** 03/01/2017