| Black Canyon Dental P C | |
|
1110 S Washington Ave Emmett ID 83617-3535 | |
| (208) 365-3860 | |
| Not Available |
| Full Name | Black Canyon Dental P C |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1110 S Washington Ave, Emmett, Idaho |
| Authorized Official Name and Position | Shon D Rooks (PRESIDENT) |
| Authorized Official Contact | 2083653860 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Canyon Dental P C 1110 S Washington Ave Emmett ID 83617-3535 Ph: (208) 365-3860 | Black Canyon Dental P C 1110 S Washington Ave Emmett ID 83617-3535 Ph: (208) 365-3860 |
| NPI Number | 1679732804 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 06/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679732804 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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