Organization
IDAHO PEDIATRIC DENTISTRY
Active
Organization
IDAHO PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHI A NELSON (OFFICE MANAGER)
(208) 461-5459
Entity
Organization
Contact information
Practice address
4401 E FLAMINGO AVE, NAMPA, ID 83687-3113
(208) 461-5459
Mailing address
4401 E FLAMINGO AVE, NAMPA, ID 83687-3113
(208) 461-5459
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
D3936PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805011445
—
ID
Enumeration date
06/09/2008
Last updated
06/09/2008
Update your record
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