Organization
ID SDS II PLLC
Active
Other names
Treasure Valley Orthodontics, Idaho Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE E VIAL (DIREC OF CRED AND PROV REL)
(615) 638-0303
Entity
Organization
Contact information
Practice address
625 E ALAMEDA RD, POCATELLO, ID 83201-3622
(208) 237-0005
Mailing address
1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
(615) 678-0759
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
11/02/2023
Last updated
03/05/2025
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