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General NPI Number Information
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NPI Number | 1679704647
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Entity Type | Organization
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Legal Business Name | COMFORT CARE DENTAL OF IDAHO FALLS, PLLC
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Dates
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Enumeration Date | 08/07/2009
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 3550 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4968
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Country | US
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Telephone | 208-524-2300
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Fax | 208-545-8447
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Provider Business Mailing Address
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Address Line | 3550 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4968
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Country | US
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Telephone | 208-524-2300
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Fax | 208-545-8447
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PHILIP HARPER
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Credential | D.M.D.
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Telephone | 208-524-2300
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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 | D4164
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D4056
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License Number State | ID
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