Organization
SOUTHRIDGE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ALAN PRATT DMD (DENTIST)
(208) 466-2458
Entity
Organization
Contact information
Practice address
2811 12TH AVE RD, NAMPA, ID 83686-8482
(208) 466-2458
(208) 465-6303
Mailing address
2811 12TH AVE RD, NAMPA, ID 83686-8482
(208) 466-2458
(208) 465-6303
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3499
ID
Other
Enumeration date
06/09/2008
Last updated
06/18/2008
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