| Avalon Dental Pc | |
|
672 E Wythe Creek Ct Ste 101 Kuna ID 83634-5216 | |
| (208) 629-2800 | |
| (208) 629-2801 |
| Full Name | Avalon Dental Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 672 E Wythe Creek Ct, Kuna, Idaho |
| Authorized Official Name and Position | James D. Grant (OWNER) |
| Authorized Official Contact | 2086292800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avalon Dental Pc 672 E Wythe Creek Ct Ste 101 Kuna ID 83634-5216 Ph: (208) 629-2800 | Avalon Dental Pc 672 E Wythe Creek Ct Ste 101 Kuna ID 83634-5216 Ph: (208) 629-2800 |
| NPI Number | 1962850933 |
|---|---|
| Provider Enumeration Date | 05/31/2016 |
| Last Update Date | 05/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962850933 | NPI | - | NPPES |
| 1447345491 | Other | ID | INDIVIDUAL PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D3875 (Idaho) | Primary |
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