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General NPI Number Information
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NPI Number | 1184482317
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Entity Type | Organization
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Legal Business Name | SAWTOOTH PERIODONTICS PLLC
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 400 S MAIN ST STE 202
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City | HAILEY
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State | ID
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Zip | 83333-8856
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Country | US
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Telephone | 208-971-4989
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Fax |
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Provider Business Mailing Address
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Address Line | 4681 S MARTINEL WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-7341
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Country | US
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Telephone | 843-530-4854
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. KIP KATSEANES
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Credential | DMD, MSD
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Telephone | 843-530-4854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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