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General NPI Number Information
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NPI Number | 1689990426
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Entity Type | Organization
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Legal Business Name | DENTURE SERVICE LLC
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Dates
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Enumeration Date | 04/19/2010
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 330 5TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2408
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Country | US
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Telephone | 208-743-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 330 5TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AARON DICKINSON
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Credential |
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Telephone | 208-743-2881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | LD-33
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License Number State | ID
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