Organization
IDENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED M MARTIN DMD (CEO)
(208) 869-2243
Entity
Organization
Contact information
Practice address
115 S MAIN ST, HOMEDALE, ID 83628-3415
(208) 869-2243
Mailing address
15111 KINGS ROW RD, CALDWELL, ID 83607-8371
(208) 869-2243
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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