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Organization

CHILDRENS DENTISTRY

Active
Parent organization
CHILDRENS DENTISTRY OF IDAHO
Organization subpart
Yes

Provider details

NPI number
Legal business name
CHILDRENS DENTISTRY OF IDAHO
Authorized official
DR. JEFFREY C BRYSON DDS (OWNER)
(208) 467-5100
Entity
Organization

Contact information

Practice address
515 W IDAHO AVE, ONTARIO, OR 97914-2348
(541) 709-5500
(208) 467-5199
Mailing address
515 W IDAHO AVE, ONTARIO, OR 97914-2348
(541) 709-5500
(208) 467-5199

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D10349
OR

Other

Enumeration date
03/01/2017
Last updated
03/01/2017
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