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General NPI Number Information
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NPI Number | 1891478723
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Entity Type | Organization
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Legal Business Name | WEST WIND DENTAL
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 243 E FREMONT AVE
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City | RIGBY
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State | ID
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Zip | 83442-1410
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Country | US
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Telephone | 208-745-0400
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Fax | 208-745-5005
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Provider Business Mailing Address
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Address Line | 243 E FREMONT AVE
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City | RIGBY
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State | ID
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Zip | 83442-1410
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Country | US
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Telephone | 208-745-0400
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Fax | 208-745-5005
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARCI ANDERSEN
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Credential |
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Telephone | 208-745-0400
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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 |
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License Number State |
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