Individual
DR. PATRICK L WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4101 CLOCK TOWER AVE, CALDWELL, ID 83607
(208) 455-0022
Mailing address
4101 CLOCK TOWER AVE, CALDWELL, ID 83607
(208) 455-0022
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3975
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807500200
—
ID
Enumeration date
02/12/2007
Last updated
12/21/2017
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