MEDICARE: DR. WADE AUSTEN PILLING D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3877	ID

General Provider Information

NPI Number	:	1578571832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WADE AUSTEN PILLING D.M.D.

Provider Business Mailing Address
First Line	:	4795 N. SUMMIT WAY
Second Line	:	SUITE 1120
City	:	MERIDIAN
State	:	ID
Zip	:	83642
Country	:	US
Telephone Number	:	208-888-0662
Fax Number	:	208-888-0863

Provider Business Practice Location Address
First Line	:	4795 N. SUMMIT WAY
Second Line	:	SUITE 1120
City	:	MERIDIAN
State	:	ID
Zip	:	83646
Country	:	US
Telephone Number	:	208-888-0662
Fax Number	:	208-888-0863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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