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Organization
DANSIE DENTAL
Active
Organization
DANSIE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI L RADFORD (OFFICE MANAGER)
(208) 745-1911
Entity
Organization
Contact information
Practice address
302 N 3823 E, RIGBY, ID 83442-5723
(208) 745-1911
(208) 745-8566
Mailing address
302 NORTH 3823 EAST, RIGBY, ID 83442
(208) 745-1911
(208) 745-8566
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4055
ID
1223G0001X
General Practice Dentistry
D4717
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807791400
—
ID
Enumeration date
05/04/2016
Last updated
05/04/2016
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