Organization
EDGEWATER DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA MILICH (RECEPTIONIST)
(208) 463-9600
Entity
Organization
Contact information
Practice address
1436 S EDGEWATER CIR, NAMPA, ID 83686
(208) 463-9600
(208) 461-3156
Mailing address
1436 S EDGEWATER CIR, NAMPA, ID 83686-5051
(208) 463-9600
(208) 461-3156
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
3315
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9201655
IDAHO SMILES
ID
Enumeration date
04/01/2008
Last updated
04/01/2008
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