Organization
AVALON DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES D. GRANT DMD (OWNER)
(208) 629-2800
Entity
Organization
Contact information
Practice address
672 E WYTHE CREEK CT, STE 101, KUNA, ID 83634-5216
(208) 629-2800
(208) 629-2801
Mailing address
672 E WYTHE CREEK CT, STE 101, KUNA, ID 83634-5216
(208) 629-2800
(208) 629-2801
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D3875
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447345491
INDIVIDUAL PROVIDER
ID
Enumeration date
05/31/2016
Last updated
05/31/2016
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