Organization
IDAHO DENTAL PROFESSIONALS, P.C.
Active
Parent organization
IDAHO DENTAL PROFESSIONALS, P.C.
Other names
South Corner Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
IDAHO DENTAL PROFESSIONALS, P.C.
Authorized official
CEMYIRA MCDOUGAL (CREDENTIALING COORDINATOR)
(217) 764-8609
Entity
Organization
Contact information
Practice address
4701 S EAGLE RD. STE. 100, MERIDIAN, ID 83642-7563
(208) 900-3350
(208) 900-3425
Mailing address
4701 S EAGLE RD. STE. 100, MERIDIAN, ID 83642-7563
(208) 900-3350
(208) 900-3425
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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