Organization
MAGIC VALLEY FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE J MALLORY (OFFICE MANAGER)
(208) 436-4532
Entity
Organization
Contact information
Practice address
115 W 100 S, RUPERT, ID 83350-9125
(208) 436-4532
Mailing address
115 W 100 S, RUPERT, ID 83350-9125
(208) 436-4532
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3903
ID
Other
Enumeration date
03/11/2008
Last updated
03/11/2008
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