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General NPI Number Information
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NPI Number | 1578958252
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Entity Type | Organization
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Legal Business Name | BLACKFOOT FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 380 W JUDICIAL ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2122
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Country | US
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Telephone | 208-785-6833
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Fax | 208-785-5362
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Provider Business Mailing Address
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Address Line | 380 W JUDICIAL ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2122
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Country | US
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Telephone | 208-785-6833
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Fax | 208-785-5362
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CADE G BALDWIN
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Credential | DDS
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Telephone | 208-785-6833
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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 | D3690
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License Number State | ID
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