Organization
ATWOOD FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRODIE STEVEN ATWOOD D.M.D (PRESIDENT)
(208) 313-0520
Entity
Organization
Contact information
Practice address
1759 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 313-0520
Mailing address
1759 W BROADWAY ST, IDAHO FALLS, ID 83402-3045
(208) 313-0520
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D4289
ID
Other
Enumeration date
03/24/2011
Last updated
03/24/2011
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