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General NPI Number Information
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NPI Number | 1376922179
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Entity Type | Organization
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Legal Business Name | AMERICAN FALLS DENTAL
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 239 IDAHO ST
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City | AMERICAN FALLS
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State | ID
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Zip | 83211-1235
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Country | US
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Telephone | 208-904-3496
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Fax | 208-904-3514
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Provider Business Mailing Address
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Address Line | 239 IDAHO ST
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City | AMERICAN FALLS
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State | ID
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Zip | 83211-1235
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Country | US
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Telephone | 208-904-3496
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Fax | 208-904-3514
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID STERZER
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Credential | DDS
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Telephone | 208-904-3496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3963
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1967
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D4634
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License Number State | ID
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