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Organization

EAGLE ROCK DENTAL CARE ARCO PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRUDEE L CHAPPLE (OFFICE ADMINISTRATOR)
(208) 523-5400
Entity
Organization

Contact information

Practice address
520 HIGHLAND DR., ARCO, ID 83213
(208) 527-3472
Mailing address
520 HIGHLAND DR., PO BOX 5, ARCO, ID 83213
(208) 527-3472

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
D-3271
ID
122300000X
Dentist
D4224
ID
1223G0001X
General Practice Dentistry
D1608
ID
1223G0001X
General Practice Dentistry
Primary
D1890
ID
1223G0001X
General Practice Dentistry
D3063
ID
1223G0001X
General Practice Dentistry
D4138
ID

Other

Enumeration date
08/07/2012
Last updated
03/14/2014
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