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General NPI Number Information
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NPI Number | 1831678903
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Entity Type | Organization
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Legal Business Name | TOWN SQUARE DENTAL PARTNERS, PLLC
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 8660 W EMERALD ST STE 152
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City | BOISE
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State | ID
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Zip | 83704-4828
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Country | US
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Telephone | 208-639-4390
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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 | 208-466-8400
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. KLINT R KELLER
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Credential | DDS
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Telephone | 208-466-8400
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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 |
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License Number State |
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