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General NPI Number Information
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NPI Number | 1447864384
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Entity Type | Organization
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Legal Business Name | KUNA KIDS DENTISTRY PC
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 1378 N. MERIDIAN ROAD STE 150
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City | KUNA
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State | ID
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Zip | 83634
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Country | US
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Telephone | 208-971-0396
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Fax |
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Provider Business Mailing Address
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Address Line | 7887 E BELLEVIEW AVE STE 250
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City | ENGLEWOOD
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State | CO
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Zip | 80111-6011
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Country | US
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Telephone | 720-603-4788
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MADISON LEHMAN
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Credential |
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Telephone | 720-603-4779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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