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General NPI Number Information
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NPI Number | 1205330420
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Entity Type | Organization
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Legal Business Name | JENDY PLLC
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 2300 W EVEREST LN STE 125
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City | MERIDIAN
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State | ID
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Zip | 83646-6113
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Country | US
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Telephone | 208-938-6343
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Fax |
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Provider Business Mailing Address
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Address Line | 3235 N TOWERBRIDGE WAY STE 200
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City | MERIDIAN
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State | ID
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Zip | 83646-5721
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Country | US
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Telephone | 208-888-7711
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL E WHITT
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Credential | DMD
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Telephone | 208-631-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D3868-PD
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License Number State | ID
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