# KOOTENAI FAMILY DENTAL, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kootenai Family Dental, PA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942317664
- **Authorized official:** DR. ROBERT L WILDER DDS (DENTIST)
- **Authorized official phone:** (208) 664-8283

## Contact information

- **Practice address:** 1420 LINCOLN WAY, SUITE 200, COEUR DALENE, ID 83814
- **Practice address phone:** (208) 664-8283
- **Practice address fax:** (208) 667-0794
- **Mailing address:** 1420 LINCOLN WAY, SUITE 200, COEUR DALENE, ID 83814
- **Mailing address phone:** (208) 664-8283
- **Mailing address fax:** (208) 667-0794

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 3794 | ID | Yes |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 10/06/2008