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Organization
COEUR D'ALENE DENTURE CLINIC LLC
Active
Organization
COEUR D'ALENE DENTURE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAUSHA MANNON (CLINICAL OWNER)
(208) 930-9464
Entity
Organization
Contact information
Practice address
1119 N 4TH ST, COEUR D ALENE, ID 83814-3216
(208) 667-8997
Mailing address
1119 N 4TH ST, COEUR D ALENE, ID 83814-3216
(208) 667-8997
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
—
—
Other
Enumeration date
08/19/2026
Last updated
08/19/2026
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