# EDGEWATER DENTAL

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

## Provider details

- **NPI number:** 1891967659
- **Authorized official:** RHONDA MILICH (RECEPTIONIST)
- **Authorized official phone:** (208) 463-9600

## Contact information

- **Practice address:** 1436 S EDGEWATER CIR, NAMPA, ID 83686
- **Practice address phone:** (208) 463-9600
- **Practice address fax:** (208) 461-3156
- **Mailing address:** 1436 S EDGEWATER CIR, NAMPA, ID 83686-5051
- **Mailing address phone:** (208) 463-9600
- **Mailing address fax:** (208) 461-3156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 3315 | ID | Yes |

## Other

- **Enumeration date:** 04/01/2008
- **Last updated:** 04/01/2008