Organization
DAN STREEBY, D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN ROBERT STREEBY DDS (OWNER)
(208) 939-0600
Entity
Organization
Contact information
Practice address
450 W STATE ST STE 180, EAGLE, ID 83616-6974
(208) 939-0600
(208) 939-0774
Mailing address
450 W STATE ST STE 180, EAGLE, ID 83616-6974
(208) 939-0600
(208) 939-0774
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28911
—
ID
Enumeration date
05/27/2020
Last updated
05/27/2020
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