| Heritage Health Dental | |
|
1090 West Park Place Suite B Coeur D Alene ID 83814 | |
| (208) 292-0303 | |
| (208) 664-5346 |
| Full Name | Heritage Health Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 1090 West Park Place, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Mike Baker (CEO) |
| Authorized Official Contact | 2086205200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Health Dental Po Box 1387 Hayden ID 83835-1387 Ph: (208) 620-5200 | Heritage Health Dental 1090 West Park Place Suite B Coeur D Alene ID 83814 Ph: (208) 292-0303 |
| NPI Number | 1447305610 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 08/24/2023 |
| Medicare PECOS PAC ID | 2466353354 |
|---|---|
| Medicare Enrollment ID | O20070924000302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447305610 | NPI | - | NPPES |
| DD0229 | Other | ID | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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