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General NPI Number Information
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NPI Number | 1851404032
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Entity Type | Organization
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Legal Business Name | GARY SCHNELL DDS
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1417 S KIMBALL AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4544
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Country | US
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Telephone | 208-459-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 S KIMBALL AVE
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City | CALDWELL
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State | ID
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Zip | 83605-4544
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Country | US
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Telephone | 208-459-8505
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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 | DONNA J CARPER
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Credential |
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Telephone | 208-459-8505
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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 | D3073
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License Number State | ID
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