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General NPI Number Information
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NPI Number | 1700447596
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Entity Type | Organization
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Legal Business Name | IDAHO FALLS PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 3015 EAGLE DR
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City | AMMON
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State | ID
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Zip | 83406-1273
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Country | US
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Telephone | 208-419-3622
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Fax | 208-419-3461
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Provider Business Mailing Address
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Address Line | 3387 MERLIN DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7405
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Country | US
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Telephone | 208-419-3622
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Fax | 208-419-3461
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Authorized Official
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Title or Position | PEDIATRIC DENTIST, OWNER
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Name | DR. KAILEY ANNE HOUSLEY
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Credential | DDS
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Telephone | 208-419-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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