Organization
KSS DENTAL GROUP PLLC
Active
Parent organization
KSS DENTAL GROUP PLLC
Other names
Fairview Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
KSS DENTAL GROUP PLLC
Authorized official
DR. KEITH L STUCKI DMD (MANAGER)
(208) 459-3388
Entity
Organization
Contact information
Practice address
329 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-3388
(208) 453-9295
Mailing address
329 E LOGAN ST, CALDWELL, ID 83605-4863
(208) 459-3388
(208) 453-9295
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3315
ID
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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