Organization
PEDIATRIC DENTISTRY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODMAN O EMORY D.D.S. (PRESIDENT/PEDIATRIC DENTIST)
(208) 377-2072
Entity
Organization
Contact information
Practice address
13014 W PERSIMMON LN, BOISE, ID 83713-1986
(208) 377-2072
Mailing address
13014 W PERSIMMON LN, BOISE, ID 83713-1986
(208) 377-2072
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-1703
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002697900
—
ID
Enumeration date
11/02/2009
Last updated
11/02/2009
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