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Organization

DANSIE DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KRISTI L RADFORD (OFFICE MANAGER)
(208) 745-1911
Entity
Organization

Contact information

Practice address
302 N 3823 E, RIGBY, ID 83442-5723
(208) 745-1911
(208) 745-8566
Mailing address
302 NORTH 3823 EAST, RIGBY, ID 83442
(208) 745-1911
(208) 745-8566

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D4055
ID
1223G0001X
General Practice Dentistry
D4717
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807791400
ID
Enumeration date
05/04/2016
Last updated
05/04/2016
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