Organization
FAMLIY DENTAL HEALTH CENTER
Active
Other names
Burtenshaw Craig A & G Staley GPS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GALEN JAY STALEY DDS (PARTNER)
(208) 529-0120
Entity
Organization
Contact information
Practice address
200 N WOODRUFF AVE, IDAHO FALLS, ID 83401-4334
(208) 529-0120
Mailing address
200 N WOODRUFF AVE, IDAHO FALLS, ID 83401-4334
(208) 529-0120
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D1628
ID
122300000X
Dentist
D3038
ID
122300000X
Dentist
Primary
D3064
ID
122300000X
Dentist
D3614
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00274600
—
ID
05
—
02740700
—
ID
05
—
806335900
—
ID
05
—
806939100
—
ID
Enumeration date
03/24/2008
Last updated
06/19/2008
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