Individual
MEGAN PETERSON WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
16145 N HIGH DESERT ST, NAMPA, ID 83687-5510
(855) 433-6825
Mailing address
1399 W ULTAR DR, NAMPA, ID 83686-6925
(801) 870-3361
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5647
ID
Other
Enumeration date
06/25/2024
Last updated
08/12/2024
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