Individual
JOHN R UKICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1717 LINCOLN WAY, SUITE 205, COEUR D ALENE, ID 83814-2556
(208) 667-3556
(208) 664-6814
Mailing address
1492 E TWISTWOOD DR, HAYDEN LAKE, ID 83835-7258
(208) 667-3556
(208) 664-6814
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3742
ID
Other
Enumeration date
01/23/2007
Last updated
07/09/2007
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