Organization
DENTISTRY FOR KIDS P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT D. MCWHORTER D.D.S. (OWNER/PRESIDENT)
(208) 237-1567
Entity
Organization
Contact information
Practice address
1014 ERIKSON DR #A, REXBURG, ID 83440
(208) 238-1567
Mailing address
1014 ERIKSON DR. #A, REXBURG, ID 83440
(208) 238-1567
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-3451-PD
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805759500
—
ID
01
—
9200611
IDAHO SMILES PROVIDER
ID
Enumeration date
04/23/2008
Last updated
02/01/2013
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