Healthcare Provider Details

I. General information

NPI: 1770493827
Provider Name (Legal Business Name): WESTON FRANDSEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 CENTER ST W
KIMBERLY ID
83341-1722
US

IV. Provider business mailing address

702 CENTER ST W
KIMBERLY ID
83341-1722
US

V. Phone/Fax

Practice location:
  • Phone: 208-423-6444
  • Fax: 208-423-6903
Mailing address:
  • Phone: 208-423-6444
  • Fax: 208-423-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: WESTON FRANDSEN
Title or Position: DENTIST
Credential: DMD
Phone: 208-423-6444