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General NPI Number Information
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NPI Number | 1447419866
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Entity Type | Organization
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Legal Business Name | JACK D.KLURE, DDS PLLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 110 E USTICK RD
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City | MERIDIAN
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State | ID
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Zip | 83646-5502
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Country | US
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Telephone | 208-888-9399
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Fax | 208-888-6115
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Provider Business Mailing Address
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Address Line | 110 E USTICK RD
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City | MERIDIAN
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State | ID
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Zip | 83646-5502
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Country | US
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Telephone | 208-888-9399
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Fax | 208-888-6115
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK D KLURE
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Credential | D.D.S.
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Telephone | 208-888-9399
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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 | D3151
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License Number State | ID
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