| Dentistry For Kids P.a. | |
|
1014 Erikson Dr #a Rexburg ID 83440 | |
| (208) 238-1567 | |
| Not Available |
| Full Name | Dentistry For Kids P.a. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1014 Erikson Dr #a, Rexburg, Idaho |
| Authorized Official Name and Position | Robert D. Mcwhorter (OWNER/PRESIDENT) |
| Authorized Official Contact | 2082371567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentistry For Kids P.a. 1014 Erikson Dr. #a Rexburg ID 83440 Ph: (208) 238-1567 | Dentistry For Kids P.a. 1014 Erikson Dr #a Rexburg ID 83440 Ph: (208) 238-1567 |
| NPI Number | 1891960688 |
|---|---|
| Provider Enumeration Date | 04/23/2008 |
| Last Update Date | 02/01/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891960688 | NPI | - | NPPES |
| 805759500 | Medicaid | ID | |
| 9200611 | Other | ID | IDAHO SMILES PROVIDER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D-3451-PD (Idaho) | Primary |
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