Organization
PARKWEST DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT D. JACOBSON DDS (OWNER/DENTIST)
(208) 524-0870
Entity
Organization
Contact information
Practice address
1088 N SKYLINE DR, IDAHO FALLS, ID 83402-1726
(208) 524-0870
(208) 524-0873
Mailing address
885 PANCHERI DR, IDAHO FALLS, ID 83402-3344
(208) 524-0870
(208) 524-0873
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-3203
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003552200
—
ID
Enumeration date
04/22/2008
Last updated
08/07/2020
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