Organization
ALEXANDER DENTAL GROUOP CHTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE SHARP (OFFICE MANAGER)
(208) 733-7566
Entity
Organization
Contact information
Practice address
506 HANSEN ST E, TWIN FALLS, ID 83301-6254
(208) 733-7566
(208) 734-4267
Mailing address
506 HANSEN ST E, TWIN FALLS, ID 83301-6254
(208) 733-7566
(208) 734-4267
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181859
IDAHO SMILES
ID
Enumeration date
04/07/2008
Last updated
04/07/2008
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