MEDICARE: CD ORTHODONTICS PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1972383941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CD ORTHODONTICS PLLC

Provider Business Mailing Address
First Line	:	349 W IOWA AVE STE 103
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-2856
Country	:	US
Telephone Number	:	208-467-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2721 S 10TH AVE
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-5792
Country	:	US
Telephone Number	:	208-467-5100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL PYSNAK
Credential	:	DMD
Telephone Number	:	208-467-5100

Provider Enumeration Date	:	10/05/2023
Last Update Date	:	10/05/2023

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Directions to “CD ORTHODONTICS PLLC ” Practice Location

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