Organization
JEROME TOOTHTOWN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE IVIE (MANAGER)
(208) 539-9876
Entity
Organization
Contact information
Practice address
1555 S LINCOLN AVE, JEROME, ID 83338-6136
(208) 539-9876
Mailing address
1555 S LINCOLN AVE, JEROME, ID 83338-6136
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
05/25/2022
Last updated
05/25/2022
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