| Dan Streeby, D.D.S. | |
|
450 W State St Ste 180 Eagle ID 83616-6974 | |
| (208) 939-0600 | |
| (208) 939-0774 |
| Full Name | Dan Streeby, D.D.S. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 450 W State St Ste 180, Eagle, Idaho |
| Authorized Official Name and Position | Dan Robert Streeby (OWNER) |
| Authorized Official Contact | 2089390600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dan Streeby, D.D.S. 450 W State St Ste 180 Eagle ID 83616-6974 Ph: (208) 939-0600 | Dan Streeby, D.D.S. 450 W State St Ste 180 Eagle ID 83616-6974 Ph: (208) 939-0600 |
| NPI Number | 1861015653 |
|---|---|
| Provider Enumeration Date | 05/27/2020 |
| Last Update Date | 05/27/2020 |
| Certification Date | 05/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861015653 | NPI | - | NPPES |
| 28911 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
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