=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992108708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARON LIND DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2014
-----------------------------------------------------
Last Update Date | 01/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2320 E GALA ST STE 200
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-4880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-846-8847
-----------------------------------------------------
Fax | 208-288-2786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2320 E GALA ST STE 200
-----------------------------------------------------
City | MERIDIAN
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83642-4880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-846-8847
-----------------------------------------------------
Fax | 208-288-2786
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. DARON J. LIND
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 208-846-8847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | D4189
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------