Organization
POTLATCH FAMILY DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMMON MICHAEL PITT D.D.S. (DENTIST)
(208) 875-0441
Entity
Organization
Contact information
Practice address
225 6TH STREET, POTLATCH, ID 83855
(208) 875-0441
(208) 875-0972
Mailing address
PO BOX 601, POTLATCH, ID 83855-0601
(208) 875-0441
(208) 875-0972
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3984
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8075010
—
ID
Enumeration date
10/15/2011
Last updated
10/15/2011
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