| Bluesky Dental | |
|
2500 W A St Ste 204 Moscow ID 83843-6000 | |
| (208) 882-9111 | |
| (208) 882-3279 |
| Full Name | Bluesky Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2500 W A St Ste 204, Moscow, Idaho |
| Authorized Official Name and Position | Kevin C Henry (OWNER) |
| Authorized Official Contact | 2088829111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluesky Dental 2500 W A St Ste 204 Moscow ID 83843-6000 Ph: (208) 882-9111 | Bluesky Dental 2500 W A St Ste 204 Moscow ID 83843-6000 Ph: (208) 882-9111 |
| NPI Number | 1073808333 |
|---|---|
| Provider Enumeration Date | 06/15/2011 |
| Last Update Date | 06/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073808333 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3597 (Idaho) | Primary |
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