Organization
IKDO SOUTH MERIDIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D PAYNE DMD (OWNER)
(208) 884-4466
Entity
Organization
Contact information
Practice address
3839 E AMITY RD, MERIDIAN, ID 83642
(208) 999-4999
Mailing address
3289 N TOWERBRIDGE WAY, MERIDIAN, ID 83646-8347
(208) 884-4466
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
05/07/2020
Last updated
05/07/2020
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