Organization
BLUE CREEK ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ANTHONY EATON DDS (PRESIDENT)
(901) 267-2294
Entity
Organization
Contact information
Practice address
3240 E LOUISE DR, SUITE 110, MERIDIAN, ID 83642-5107
(208) 578-4700
(208) 578-4704
Mailing address
3240 E LOUISE DR, SUITE 110, MERIDIAN, ID 83642-5107
(208) 578-4700
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D-4611-EN
ID
Other
Enumeration date
11/12/2014
Last updated
11/12/2014
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