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General NPI Number Information
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NPI Number | 1801274253
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Entity Type | Organization
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Legal Business Name | PLAYHOUSE DENTISTRY FOR KIDS
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 125 S 10TH E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-3120
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Country | US
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Telephone | 208-453-6188
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Fax |
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Provider Business Mailing Address
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Address Line | 125 S 10TH E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-3120
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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 | OFFICE MANAGER
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Name | RHONDA ELQUIST
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Credential |
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Telephone | 208-453-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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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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