| Clock Tower Orthodontics, Pc | |
|
4203 Clock Tower Ave Caldwell ID 83607-5236 | |
| (208) 454-4112 | |
| (208) 454-5155 |
| Full Name | Clock Tower Orthodontics, Pc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4203 Clock Tower Ave, Caldwell, Idaho |
| Authorized Official Name and Position | Loren E Short (PRESIDENT) |
| Authorized Official Contact | 2084544112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clock Tower Orthodontics, Pc 4203 Clock Tower Ave Caldwell ID 83607-5236 Ph: (208) 454-4112 | Clock Tower Orthodontics, Pc 4203 Clock Tower Ave Caldwell ID 83607-5236 Ph: (208) 454-4112 |
| NPI Number | 1942471966 |
|---|---|
| Provider Enumeration Date | 03/18/2008 |
| Last Update Date | 03/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942471966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D-4121-OR (Idaho) | Primary |
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