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General NPI Number Information
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NPI Number | 1972765865
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Entity Type | Organization
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Legal Business Name | POPPLETON FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 1001 SHOSHONE ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6364
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Country | US
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Telephone | 208-733-0695
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Fax | 208-736-4540
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Provider Business Mailing Address
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Address Line | 1001 SHOSHONE ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6364
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE DAVID POPPLETON
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Credential | D.D.S.
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Telephone | 208-733-0695
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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 | D-3554
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License Number State | ID
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