Organization
ID SPECIALTY DENTAL SERVICES, PLLC
Active
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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