Organization
KOOTENAI DENTAL GROUP, LLC
Active
Other names
DeLwyn Lee Dick, D.D.S.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DELWYN LEE DICK DDS (CEO)
(208) 762-8750
Entity
Organization
Contact information
Practice address
555 W. CANFIELD AVENUE, COEUR D'ALENE, ID 83815-7892
(208) 762-8750
(208) 762-2530
Mailing address
555 W. CANFIELD AVENUE, COEUR D'ALENE, ID 83815-7892
(208) 762-8750
(208) 762-2530
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
ID03049
ID
Other
Enumeration date
09/22/2006
Last updated
08/22/2020
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