Organization
IKDO STAR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL D PAYNE DMD (OWNER)
(208) 884-4466
Entity
Organization
Contact information
Practice address
12190 W EVELY PINES LN, STAR, ID 83669-6126
(208) 884-4466
Mailing address
3289 N TOWERBRIDGE WAY, MERIDIAN, ID 83646-8347
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
04/04/2019
Last updated
05/08/2020
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