Organization
PLAYHOUSE DENTISTRY FOR KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA ELQUIST (OFFICE MANAGER)
(208) 453-6188
Entity
Organization
Contact information
Practice address
125 S 10TH E, MOUNTAIN HOME, ID 83647-3120
(208) 453-6188
Mailing address
125 S 10TH E, MOUNTAIN HOME, ID 83647-3120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
05/18/2015
Last updated
06/08/2015
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