Organization
THE FAMILY DENTAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAREN J. PRUETT (OFFICE MANAGER)
(208) 785-2685
Entity
Organization
Contact information
Practice address
625 W BRIDGE ST, BLACKFOOT, ID 83221-2018
(208) 785-2685
(208) 785-0998
Mailing address
PO BOX 458, BLACKFOOT, ID 83221-0458
(208) 785-2685
(208) 785-0998
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3613
ID
Other
Enumeration date
07/16/2006
Last updated
08/22/2020
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