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General NPI Number Information
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NPI Number | 1881049278
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Entity Type | Organization
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Legal Business Name | DANSIE DENTAL
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 302 N 3823 E
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City | RIGBY
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State | ID
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Zip | 83442-5723
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Country | US
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Telephone | 208-745-1911
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Fax | 208-745-8566
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Provider Business Mailing Address
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Address Line | 302 NORTH 3823 EAST
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City | RIGBY
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State | ID
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Zip | 83442
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Country | US
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Telephone | 208-745-1911
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Fax | 208-745-8566
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTI L RADFORD
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Credential |
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Telephone | 208-745-1911
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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 | D4717
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D4055
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License Number State | ID
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