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General NPI Number Information
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NPI Number | 1861015653
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Entity Type | Organization
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Legal Business Name | DAN STREEBY, D.D.S.
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | 450 W STATE ST STE 180
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City | EAGLE
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State | ID
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Zip | 83616-6974
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Country | US
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Telephone | 208-939-0600
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Fax | 208-939-0774
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Provider Business Mailing Address
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Address Line | 450 W STATE ST STE 180
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City | EAGLE
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State | ID
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Zip | 83616-6974
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Country | US
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Telephone | 208-939-0600
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Fax | 208-939-0774
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAN ROBERT STREEBY
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Credential | DDS
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Telephone | 208-939-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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