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. |
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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 |
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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 |
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Provider Enumeration Date | 05/28/2009 |
Last Update Date | 05/28/2009 |
Identifier | Type | State | Issuer |
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1174758619 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | D1572 (Idaho) | Primary |