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General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1922189109

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
1003 N 3RD ST  MCCALL, ID 83638-3822 US
Tel: 208-634-7653  Fax: 208-634-4568

Contact information for business:
1003 N 3RD ST  MCCALL, ID 83638-3822 US
Tel: 208-634-7653  Fax: 208-634-4568

Registration Information:
NPI: 1922189109
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Legacy codes, insurance codes and state license numbers:



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