Organization
IDAHO FALLS DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LARSEN (OFFICE MANAGER)
(208) 525-8383
Entity
Organization
Contact information
Practice address
2300 E 17TH ST, IDAHO FALLS, ID 83404-6504
(208) 525-8383
(208) 523-6419
Mailing address
PO BOX 2046, IDAHO FALLS, ID 83403-2046
(208) 525-8383
(208) 523-6419
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
01/07/2007
Last updated
08/22/2020
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