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Organization
PONDERAY NEWCO PLLC
Active
Organization
PONDERAY NEWCO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KORY WILSON DDS (CEO)
(208) 661-7879
Entity
Organization
Contact information
Practice address
476653 HIGHWAY 95 STE 1, PONDERAY, ID 83852-9816
(208) 265-6771
Mailing address
476653 HIGHWAY 95 STE 1, PONDERAY, ID 83852-9816
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/15/2026
Last updated
09/15/2026
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