Healthcare Provider Details
I. General information
NPI: 1013187913
Provider Name (Legal Business Name): ARIEL, INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1208 11TH ST S
NAMPA ID
83651-4654
US
IV. Provider business mailing address
1208 11TH ST S
NAMPA ID
83651-4654
US
V. Phone/Fax
- Phone: 208-463-1800
- Fax:
- Phone: 208-463-1800
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 122300000X |
| Taxonomy | Dentist |
| License Number | D3096 |
| License Number State | ID |
VIII. Authorized Official
Name: DR.
RONALD
J
ALBRIGHT
Title or Position: PRES
Credential: DDS
Phone: 208-463-1800