# FAIRVIEW DENTAL PLLC

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

## Provider details

- **NPI number:** 1992480404
- **Authorized official:** SEAN WASDEN (COO)
- **Authorized official phone:** (208) 965-9415

## Contact information

- **Practice address:** 329 E LOGAN ST, CALDWELL, ID 83605-4863
- **Practice address phone:** (208) 459-3388
- **Mailing address:** 624 3RD ST S, NAMPA, ID 83651-3840
- **Mailing address phone:** (208) 965-9415

## Taxonomy

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

## Other

- **Enumeration date:** 06/21/2023
- **Last updated:** 06/21/2023