Organization
HATHAWAY AND PELLETIER FAMILY DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN E TUINEI (CREDENTIALING MANAGER)
(602) 750-6897
Entity
Organization
Contact information
Practice address
1217 E IRON EAGLE DR, EAGLE, ID 83616-6599
(208) 377-1161
(208) 938-0567
Mailing address
1217 E IRON EAGLE DR, EAGLE, ID 83616-6599
(208) 377-1161
(208) 938-0567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/12/2020
Last updated
11/12/2020
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