Organization
BINGHAM ENDODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA DEL RIO (OFFICE MANAGER)
(208) 747-2651
Entity
Organization
Contact information
Practice address
610 W. BROADWAY AVE, JACKSON, WY 83001
(208) 227-0382
(208) 227-0384
Mailing address
3387 MERLIN DR, IDAHO FALLS, ID 83404-7405
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1191
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780859223
—
ID
Enumeration date
05/21/2012
Last updated
05/21/2012
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