Healthcare Provider Details

I. General information

NPI: 1841395589
Provider Name (Legal Business Name): POST FALLS FAMILY DENTAL CENTER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N SPOKANE ST
POST FALLS ID
83854-9513
US

IV. Provider business mailing address

313 N SPOKANE ST
POST FALLS ID
83854-9513
US

V. Phone/Fax

Practice location:
  • Phone: 208-773-4579
  • Fax: 208-773-0286
Mailing address:
  • Phone: 208-773-4579
  • Fax: 208-773-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIN ELLIOTT
Title or Position: OWNER
Credential: DDS
Phone: 208-773-4579