Organization
DENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDACE WEEKES (OFFICE COORDINATOR)
(208) 356-9262
Entity
Organization
Contact information
Practice address
56 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 356-9262
(208) 356-4804
Mailing address
56 PROFESSIONAL PLZ, REXBURG, ID 83440-2047
(208) 356-9262
(208) 356-4804
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4364
ID
1223G0001X
General Practice Dentistry
D4364
ID
332BC3200X
Customized Equipment (DME)
D-4364
ID
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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