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General NPI Number Information
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NPI Number | 1013732478
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Entity Type | Organization
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Legal Business Name | T AND H ENTERPRISES, DMD
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3315 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 208-522-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 208-522-4491
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | TODD MATHESON
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Credential | DMD
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Telephone | 208-522-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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