Organization
ONEIDA FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHENELL CLARK (OFFICE MANAGER)
(208) 904-3614
Entity
Organization
Contact information
Practice address
150 S MAIN ST APT 16, MALAD CITY, ID 83252-1405
(208) 904-3614
Mailing address
150 S MAIN ST APT 16, MALAD CITY, ID 83252-1405
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4484
ID
Other
Enumeration date
12/29/2017
Last updated
12/29/2017
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