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Organization
FAIRVIEW DENTAL PLLC
Active
Organization
FAIRVIEW DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN WASDEN (COO)
(208) 965-9415
Entity
Organization
Contact information
Practice address
329 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-3388
Mailing address
624 3RD ST S, NAMPA, ID 83651-3840
(208) 965-9415
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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