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General NPI Number Information
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NPI Number | 1558201509
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Entity Type | Organization
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Legal Business Name | LEVEL UP FAMILY DENTAL
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 1100 E RIVERSIDE DR
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City | EAGLE
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State | ID
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Zip | 83616-7707
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Country | US
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Telephone | 208-398-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 3157 N VIGO AVE
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City | STAR
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State | ID
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Zip | 83669-1066
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Country | US
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Telephone | 208-870-1778
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | GRASON JOSEPH HADFIELD
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Credential | DMD
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Telephone | 208-398-3020
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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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