Organization
SIGNATURE DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW L KOOYMAN DDS (OWNER)
(208) 884-8858
Entity
Organization
Contact information
Practice address
1500 W CAYUSE CREEK DRIVE, SUITE 100, MERIDIAN, ID 83646
(208) 884-8858
(208) 884-8915
Mailing address
1500 W CAYUSE CREEK DRIVE, SUITE 100, MERIDIAN, ID 83646
(208) 884-8858
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3565
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699782854
TYPE 1 NPI
ID
Enumeration date
06/05/2008
Last updated
06/05/2008
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