Organization
IKDO EMMETT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE A HURST (BOOKKEEPER)
(208) 283-7634
Entity
Organization
Contact information
Practice address
314 S WASHINGTON AVE, EMMETT, ID 83617-2952
(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
10/31/2019
Last updated
10/31/2019
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