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Organization
SUMMIT DENTAL CARE GROUP, PLLC
Active
Organization
SUMMIT DENTAL CARE GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISA FRAME FAADOM (PRACTICE ADMINISTRATOR)
(208) 733-9999
Entity
Organization
Contact information
Practice address
285 CANYON CREST DR, TWIN FALLS, ID 83301-5359
(208) 733-9999
(208) 733-9699
Mailing address
285 CANYON CREST DRIVE, TWIN FALLS, ID 83301
(208) 733-9999
(208) 733-9699
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3892
ID
122300000X
Dentist
D4455
ID
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807190600
—
ID
Enumeration date
06/16/2008
Last updated
02/06/2014
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