Organization
CHERRY LANE KIDS DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RHONDA MARIE ELQUIST (REGIONAL OPERATIONS MANAGER)
(208) 580-7091
Entity
Organization
Contact information
Practice address
1558 N CRESTMONT DR STE A, MERIDIAN, ID 83642-2194
(208) 580-7091
(208) 587-2624
Mailing address
121 MOUNTAIN VIEW DR, NAMPA, ID 83686-8867
(208) 760-0335
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D-4186-PD
ID
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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