| Kootenai Dental Group, Llc | |
|
555 W. Canfield Avenue Coeur D'alene ID 83815-7892 | |
| (208) 762-8750 | |
| (208) 762-2530 |
| Full Name | Kootenai Dental Group, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 555 W. Canfield Avenue, Coeur D'alene, Idaho |
| Authorized Official Name and Position | Delwyn Lee Dick (CEO) |
| Authorized Official Contact | 2087628750 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kootenai Dental Group, Llc 555 W. Canfield Avenue Coeur D'alene ID 83815-7892 Ph: (208) 762-8750 | Kootenai Dental Group, Llc 555 W. Canfield Avenue Coeur D'alene ID 83815-7892 Ph: (208) 762-8750 |
| NPI Number | 1265532261 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265532261 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | ID03049 (Idaho) | Primary |