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General NPI Number Information
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NPI Number | 1053705178
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Entity Type | Organization
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Legal Business Name | ONSITE DENTAL, PLLC
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 524 E FUJII DR
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City | NAMPA
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State | ID
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Zip | 83686-6906
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Country | US
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Telephone | 844-667-4834
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Fax | 208-376-3616
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Provider Business Mailing Address
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Address Line | 524 E FUJII DR
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City | NAMPA
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State | ID
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Zip | 83686-6906
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Country | US
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Telephone | 844-667-4834
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Fax | 208-376-3616
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | ROSE MARY MILNER
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Credential |
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Telephone | 208-514-4739
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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 | D3315
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License Number State | ID
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