Individual
DR. BRYCE A. BURTENSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 N WOODRUFF AVE, IDAHO FALLS, ID 83401-4334
(208) 529-0120
(208) 523-4711
Mailing address
200 N WOODRUFF AVE, IDAHO FALLS, ID 83401-4334
(208) 529-0120
(208) 523-4711
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3614
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806335900
—
ID
Enumeration date
05/11/2006
Last updated
05/14/2015
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