Organization
SOUTHERN SPRINGS DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BARRY W JARDINE DMD (OWNER DENTIST)
(208) 888-3540
Entity
Organization
Contact information
Practice address
1910 S MERIDIAN RD, STE 150, MERIDIAN, ID 83642-9061
(208) 888-3540
Mailing address
1910 S MERIDIAN RD, STE 150, MERIDIAN, ID 83642
(208) 888-3540
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3807
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807969400
—
ID
Enumeration date
06/09/2008
Last updated
06/09/2008
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