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General NPI Number Information
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NPI Number | 1841201548
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Entity Type | Organization
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Legal Business Name | ASSOCIATED DENTISTS OF COEUR D'ALENE, PA.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 LINCOLN WAY SUITE 100
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2570
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Country | US
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Telephone | 208-765-3322
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Fax | 208-765-1024
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Provider Business Mailing Address
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Address Line | 1800 LINCOLN WAY SUITE 100
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2570
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Country | US
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Telephone | 208-765-3322
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Fax | 208-765-1024
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. STAN RASMUSSEN
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Credential | DDS
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Telephone | 208-765-3322
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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 | D1528
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D1899
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License Number State | ID
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