Healthcare Provider Details

I. General information

NPI: 1164156238
Provider Name (Legal Business Name): EMILEE EDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 05/20/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 COMANCHE ST
BONNERS FERRY ID
83805-7523
US

IV. Provider business mailing address

132 WAPITI WAY
TROY MT
59935-9511
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-1718
  • Fax: 208-267-9197
Mailing address:
  • Phone: 720-582-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-5572
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN.00205273
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: