Organization
IDAHO PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER K LOVELAND DDS (OWNER)
(208) 461-5459
Entity
Organization
Contact information
Practice address
4401 E FLAMINGO AVE, NAMPA, ID 83687-3113
(208) 461-5459
(208) 461-6023
Mailing address
4401 E FLAMINGO AVE, NAMPA, ID 83687-3113
(208) 461-5459
(208) 461-6023
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3936
ID
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
D3908
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807511400
—
ID
05
—
808185200
—
ID
Enumeration date
12/09/2008
Last updated
12/09/2008
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