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General NPI Number Information
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NPI Number | 1316687437
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Entity Type | Organization
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Legal Business Name | ADACARE DENTAL & DENTURES PLLC
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 3909 E FAIRVIEW AVE STE 150
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City | MERIDIAN
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State | ID
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Zip | 83642-5814
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Country | US
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Telephone | 208-996-5808
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Fax | 208-996-7208
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Provider Business Mailing Address
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Address Line | 3909 E FAIRVIEW AVE STE 150
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City | MERIDIAN
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State | ID
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Zip | 83642-5814
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Country | US
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Telephone | 208-996-5808
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Fax | 208-996-7208
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARL LARSON
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Credential | DDS
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Telephone | 208-996-5808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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