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General NPI Number Information
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NPI Number | 1083279087
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Entity Type | Organization
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Legal Business Name | IDAHO BUCKEYE INC
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 1537 2ND AVE S
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City | PAYETTE
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State | ID
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Zip | 83661-2919
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Country | US
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Telephone | 208-642-4111
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Fax |
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Provider Business Mailing Address
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Address Line | 13108 W PERSIMMON LN
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City | BOISE
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State | ID
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Zip | 83713-1986
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DENNIS GARPETTI
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Credential | DDS
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Telephone | 208-377-2160
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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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