Organization
ID DENTAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERTOLLINI (PRS)
(866) 273-8204
Entity
Organization
Contact information
Practice address
2818 S 25TH E, IDAHO FALLS, ID 83404
(208) 243-8391
(208) 243-8391
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189
(866) 273-8204
(315) 410-5531
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4206
ID
Other
Enumeration date
06/27/2016
Last updated
06/27/2016
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