# ANDREA S RADABAUGH DDS PLLC

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

## Provider details

- **NPI number:** 1811281397
- **Authorized official:** DR. ANDREA S RADABAUGH DDS (OWNER DENTIST)
- **Authorized official phone:** (530) 333-7853

## Contact information

- **Practice address:** 420 DIVISION AVE, CRAIGMONT, ID 83523
- **Practice address phone:** (208) 924-5830
- **Mailing address:** PO BOX 218, CRAIGMONT, ID 83523-0218
- **Mailing address phone:** (530) 333-7853

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4296 | ID | Yes |

## Other

- **Enumeration date:** 06/02/2011
- **Last updated:** 06/21/2011