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General NPI Number Information
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NPI Number | 1336309475
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Entity Type | Organization
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Legal Business Name | GEDDES LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 12/28/2019
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Provider Practice Location Address
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Address Line | 236 RIVER VISTA PL
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City | TWIN FALLS
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State | ID
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Zip | 83301-4078
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Country | US
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Telephone | 208-352-6360
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Fax | 208-737-5255
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Provider Business Mailing Address
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Address Line | 236 RIVER VISTA PL
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City | TWIN FALLS
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State | ID
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Zip | 83301-4078
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Country | US
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Telephone | 208-352-6360
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Fax | 208-737-5255
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MATTHEW D GEDDES
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Credential | DDS
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Telephone | 208-432-2025
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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 | 1169
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License Number State | WY
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