Organization
LEGACY FAMILY DENTAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINE ELAINE GIBBON (OFFICE MANAGER)
(208) 773-1559
Entity
Organization
Contact information
Practice address
801 E MEDICAL CT, POST FALLS, ID 83854-7298
(208) 773-1559
(208) 773-9959
Mailing address
801 E MEDICAL CT, POST FALLS, ID 83854-7298
(208) 773-1559
(208) 773-9959
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4275
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093949133
DENTAL
ID
Enumeration date
03/31/2015
Last updated
11/11/2015
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