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General NPI Number Information
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NPI Number | 1972863678
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Entity Type | Organization
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Legal Business Name | DENTAL CARE FOR KIDS
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 3235 N TOWERBRIDGE WAY SUITE 200
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City | MERIDIAN
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State | ID
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Zip | 83646-5721
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Country | US
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Telephone | 208-888-7711
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Fax | 208-888-3089
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Provider Business Mailing Address
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Address Line | 3235 N TOWERBRIDGE WAY SUITE 200
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City | MERIDIAN
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State | ID
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Zip | 83646-5721
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Country | US
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Telephone | 208-888-7711
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Fax | 208-888-3089
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | DR. JOEL ELDON WHITT
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Credential | DMD
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Telephone | 208-888-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D-3868
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License Number State | ID
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