Organization
NS SOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM BENSON KELLER DDS (OWNER/DENTIST)
(208) 466-2456
Entity
Organization
Contact information
Practice address
1705 12TH AVE RD, NAMPA, ID 83686-6104
(208) 466-6600
(208) 466-6603
Mailing address
607 2ND ST S, NAMPA, ID 83651-3837
(208) 466-2456
(208) 318-0227
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D3065
ID
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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