Organization
TETON VALLEY DENTAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES C ALLEN DDS (PRESIDENT)
(208) 354-8181
Entity
Organization
Contact information
Practice address
235 E. WALLACE AVE., DRIGGS, ID 83442
(208) 354-8181
(208) 354-8182
Mailing address
PO BOX 791, 235 E., WALLACE AVE., DRIGGS, ID 83422-0791
(208) 354-8181
(208) 354-8182
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
D1657
ID
261QD0000X
Dental Clinic/Center
Primary
D3634
ID
Other
Enumeration date
01/25/2012
Last updated
01/25/2012
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