Individual
DR. THOMAS MATTHEW DANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1027 W. PRAIRIE AVE, HAYDEN, ID 83835
(208) 818-9432
(208) 772-2213
Mailing address
1027 W. PRAIRIE AVE, HAYDEN, ID 83835
(208) 818-9432
(208) 772-2213
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
D-4050
ID
1223P0221X
Pediatric Dentistry
Primary
D-4050-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807729000
—
ID
Enumeration date
07/03/2007
Last updated
10/17/2018
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