Organization
STOCK & GARN LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELAINE ANNETTE HANSEN (OFFICE MANAGER)
(208) 678-8188
Entity
Organization
Contact information
Practice address
2200 PARK AVE, SUITE 2, BURLEY, ID 83318-2186
(208) 678-8188
(208) 678-3170
Mailing address
2200 PARK AVE, SUITE 2, BURLEY, ID 83318-2186
(208) 678-8188
(208) 678-3170
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002656300
—
ID
05
—
804002700
—
ID
Enumeration date
04/29/2008
Last updated
04/29/2008
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