Organization
CHUBBUCK KIDZ DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAGDALENA EVANS (SR. CREDENTIALING SPECIALIST)
(720) 272-7558
Entity
Organization
Contact information
Practice address
371 E CHUBBUCK RD, CHUBBUCK, ID 83202
(208) 358-8871
Mailing address
371 E CHUBBUCK RD, CHUBBUCK, ID 83202
(208) 425-7690
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
08/17/2023
Last updated
08/18/2023
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