Organization
CHILDREN'S DENTISTRY OF IDAHO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY BRYSON D.D.S. (OWNER/DENTIST)
(208) 467-5100
Entity
Organization
Contact information
Practice address
349 W IOWA AVE, NAMPA, ID 83686-2856
(208) 467-5100
Mailing address
349 W IOWA AVE, NAMPA, ID 83686-2856
(208) 467-5100
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-4399-PD
ID
Other
Enumeration date
12/02/2011
Last updated
11/08/2021
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