NPI Registry
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Organization

CLOCK TOWER ORTHODONTICS, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LOREN E SHORT DMD (PRESIDENT)
(208) 454-4112
Entity
Organization

Contact information

Practice address
4203 CLOCK TOWER AVE, CALDWELL, ID 83607-5236
(208) 454-4112
(208) 454-5155
Mailing address
4203 CLOCK TOWER AVE, CALDWELL, ID 83607-5236
(208) 454-4112
(208) 454-5155

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-4121-OR
ID

Other

Enumeration date
03/18/2008
Last updated
03/18/2008
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