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General NPI Number Information
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NPI Number | 1760094007
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Entity Type | Organization
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Legal Business Name | POPE PLACE, PLLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 2201 E GALA ST
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City | MERIDIAN
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State | ID
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Zip | 83642-2798
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Country | US
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Telephone | 208-965-9415
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Fax |
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Provider Business Mailing Address
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Address Line | 203 7TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-3846
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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 | OPERATIONS MANAGER
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Name | SEAN WASDEN
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Credential | MHS
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Telephone | 208-965-9415
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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 |
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License Number State |
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