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Organization

IDAHO PROSTHODONTICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DARREL L MOONEY D.D.S., F.A.C.P. (OWNER)
(208) 336-9333
Entity
Organization

Contact information

Practice address
347 CROOKED EAR CT, SANDPOINT, ID 83864-9477
(208) 336-9333
(208) 387-1951
Mailing address
301 S DIVISION AVE, SANDPOINT, ID 83864-2737
(208) 263-6393
(208) 263-6786

Taxonomy

Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
D1650
ID

Other

Enumeration date
06/06/2007
Last updated
08/22/2020
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