Organization
CHANNING WAY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLADE L. PETERSON D.M.D. (OWNER/PARTNER)
(208) 529-3660
Entity
Organization
Contact information
Practice address
2205 CHANNING WAY, SUITE B, IDAHO FALLS, ID 83404-8016
(208) 529-3660
(208) 529-3666
Mailing address
2205 CHANNING WAY, SUITE B, IDAHO FALLS, ID 83404-8016
(208) 529-3660
(208) 529-3666
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/12/2006
Last updated
03/25/2008
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