Individual
KURT OWEN IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
135 S STATE ST, PRESTON, ID 83263-1240
(208) 852-3700
(208) 852-3777
Mailing address
135 S STATE ST, PRESTON, ID 83263-1240
(208) 852-3700
(208) 852-3777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3402
ID
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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