# DAVIDSON FAMILY DENTAL

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

## Provider details

- **NPI number:** 1922404987
- **Authorized official:** KIRK MICHAEL DAVIDSON DDS (OWNER)
- **Authorized official phone:** (208) 667-5447

## Contact information

- **Practice address:** 509 W HANLEY AVE STE 201, COEUR D ALENE, ID 83815-8994
- **Practice address phone:** (208) 667-5447
- **Practice address fax:** (208) 666-8918
- **Mailing address:** 509 W HANLEY AVE STE 201, COEUR D ALENE, ID 83815-8994
- **Mailing address phone:** (208) 667-5447
- **Mailing address fax:** (208) 666-8918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D4322 | ID | Yes |

## Other

- **Enumeration date:** 11/18/2014
- **Last updated:** 11/18/2014