Individual
DR. RYAN T KIDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
139 ALTURAS ST, IDAHO FALLS, ID 83401-4309
(208) 523-5090
(208) 895-0583
Mailing address
139 ALTURAS ST, IDAHO FALLS, ID 83401-4309
(208) 523-5090
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4006
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807576700
—
ID
Enumeration date
11/11/2006
Last updated
06/07/2023
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