Organization
WOODLAND FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GRAHAM WELTON DDS (CEO)
(406) 366-0661
Entity
Organization
Contact information
Practice address
5082 E SHORE CV, POST FALLS, ID 83854-6888
(406) 366-0661
Mailing address
1100 E POLSTON AVE, POST FALLS, ID 83854-6045
(406) 366-0661
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D4714
ID
1223G0001X
General Practice Dentistry
Primary
D4715
ID
Other
Enumeration date
11/12/2015
Last updated
11/12/2015
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