Individual
DR. BRODIE STEVEN ATWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1759 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 313-0520
Mailing address
1759 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 313-0520
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4289
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
07/15/2009
Last updated
03/24/2011
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