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General NPI Number Information
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NPI Number | 1942508361
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Entity Type | Organization
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Legal Business Name | HARRIS & ALLEN DENTAL
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 3815 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7591
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Country | US
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Telephone | 208-529-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 3815 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7591
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Country | US
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Telephone | 208-529-4500
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT T ALLEN
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Credential |
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Telephone | 208-529-4500
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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 | D1641
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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 | D4152
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License Number State | ID
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