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General NPI Number Information
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NPI Number | 1992547442
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Entity Type | Organization
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Legal Business Name | TOWN SQUARE DENTAL-BURLEY PLLC
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Dates
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Enumeration Date | 06/06/2024
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 1010 E MAIN ST
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City | BURLEY
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State | ID
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Zip | 83318-2045
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Country | US
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Telephone | 208-678-5597
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Fax | 866-882-4187
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Provider Business Mailing Address
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Address Line | 1010 E MAIN ST
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City | BURLEY
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State | ID
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Zip | 83318-2045
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Country | US
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Telephone | 208-678-5597
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Fax | 866-882-4187
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | YURI ARTEAGA
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Credential |
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Telephone | 208-678-5597
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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 |
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License Number State |
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