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General NPI Number Information
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NPI Number | 1952316341
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Entity Type | Organization
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Legal Business Name | ASPEN VALLEY FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3423 MERLIN DRIVE SUITE 100
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-4181
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Fax | 208-523-4182
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Provider Business Mailing Address
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Address Line | 3423 MERLIN DRIVE SUITE 100
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-4181
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Fax | 208-523-4182
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MARCUS D NEFF
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Credential | DDS
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Telephone | 208-523-4181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3710
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License Number State | ID
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