Healthcare Provider Details

I. General information

NPI: 1053422691
Provider Name (Legal Business Name): BRETT D NAYLOR DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N 1ST E
PRESTON ID
83263-1325
US

IV. Provider business mailing address

25 N 1ST E
PRESTON ID
83263-1325
US

V. Phone/Fax

Practice location:
  • Phone: 208-852-0770
  • Fax: 208-852-3294
Mailing address:
  • Phone: 208-852-0770
  • Fax: 208-852-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberD3124
License Number StateID

VIII. Authorized Official

Name: DR. BRETT D NAYLOR
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 208-852-0770