Healthcare Provider Details

I. General information

NPI: 1720912132
Provider Name (Legal Business Name): EMILY TESNOHLIDEK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E CENTRAL DR
MERIDIAN ID
83642-7991
US

IV. Provider business mailing address

4505 WHITLEY DR
FRUITLAND ID
83619-5047
US

V. Phone/Fax

Practice location:
  • Phone: 208-373-1855
  • Fax:
Mailing address:
  • Phone: 208-739-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2381418
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: