Organization
CHILDRENS DENTISTRY OF FRUITLAND
Active
Parent organization
CHILDREN'S DENTISTRY OF IDAHO, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S DENTISTRY OF IDAHO, PLLC
Authorized official
RACHEL MITCHELL (BUSINESS MANAGER)
(208) 467-5100
Entity
Organization
Contact information
Practice address
1950 N WHITLEY DR, FRUITLAND, ID 83619-2143
(541) 709-5500
(208) 467-5199
Mailing address
1950 N WHITLEY DR, FRUITLAND, ID 83619-2143
(541) 709-5500
(208) 467-5199
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/18/2021
Last updated
11/18/2021
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