| Avondale Dental Center, L.l.c. | |
|
1683 E. Miles Ave. Hayden Lake ID 83835-9109 | |
| (208) 772-4066 | |
| Not Available |
| Full Name | Avondale Dental Center, L.l.c. |
|---|---|
| Speciality | Dentist |
| Location | 1683 E. Miles Ave., Hayden Lake, Idaho |
| Authorized Official Name and Position | James A Robson (OWNER) |
| Authorized Official Contact | 2087724066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avondale Dental Center, L.l.c. 1683 E Miles Ave Hayden Lake ID 83835-9109 Ph: (208) 772-4066 | Avondale Dental Center, L.l.c. 1683 E. Miles Ave. Hayden Lake ID 83835-9109 Ph: (208) 772-4066 |
| NPI Number | 1174758619 |
|---|---|
| Provider Enumeration Date | 05/28/2009 |
| Last Update Date | 05/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174758619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D1572 (Idaho) | Primary |