Organization
BIRD FAMILY DENTAL IDAHO FALLS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYSON ANDERS BIRD DDS (OWNER/PRESIDENT)
(208) 680-5144
Entity
Organization
Contact information
Practice address
2960 CORTEZ AVE, IDAHO FALLS, ID 83404-7554
(208) 680-5144
(208) 680-5144
Mailing address
1392 N 800 E, SHELLEY, ID 83274-5013
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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