Organization
IKDO FRUITLAND LLC
Active
Other names
Idaho Kids Dentistry & Orthodontics Fruitland
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D PAYNE DMD (PRESIDENT)
(208) 371-4445
Entity
Organization
Contact information
Practice address
1619 N WHITLEY DR, FRUITLAND, ID 83619-2162
(208) 452-4444
(208) 452-3322
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
09/19/2018
Last updated
04/16/2019
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