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General NPI Number Information
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NPI Number | 1346122488
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Entity Type | Organization
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Legal Business Name | NORTHWEST NATURAL DENTISTRY GPS PLLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 8382 N WAYNE DR STE 202
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City | HAYDEN
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State | ID
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Zip | 83835-6028
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Country | US
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Telephone | 208-667-4844
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Fax |
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Provider Business Mailing Address
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Address Line | 8382 N WAYNE DR STE 202
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City | HAYDEN
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State | ID
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Zip | 83835-6028
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Country | US
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Telephone | 208-667-4844
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM LITTLE
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Credential |
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Telephone | 208-667-4844
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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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