Organization
ID SPECIALTY DENTAL SERVICES, PLLC
Active
Other names
Specialty Dental Brands
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE DASCH (DIRECTOR OF OPERATIONS)
(504) 638-0303
Entity
Organization
Contact information
Practice address
1327 N MERIDIAN RD STE 40, KUNA, ID 83634-1761
(208) 898-0000
Mailing address
401 CHURCH ST STE 1400, NASHVILLE, TN 37219-2214
(504) 638-0303
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
02/12/2021
Last updated
02/12/2021
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