| Avondale Dental Center, Llc | |
|
700 Ironwood Dr #366 Coeur D'alene ID 83814 | |
| (208) 664-2160 | |
| (208) 930-4085 |
| Full Name | Avondale Dental Center, Llc |
|---|---|
| Speciality | Dentist |
| Location | 700 Ironwood Dr, Coeur D'alene, Idaho |
| Authorized Official Name and Position | James Robson (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2087724066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avondale Dental Center, Llc 700 Ironwood Dr #366 Coeur D'alene ID 83814 Ph: (208) 664-2160 | Avondale Dental Center, Llc 700 Ironwood Dr #366 Coeur D'alene ID 83814 Ph: (208) 664-2160 |
| NPI Number | 1558887067 |
|---|---|
| Provider Enumeration Date | 08/16/2017 |
| Last Update Date | 08/16/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558887067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D-4015 (Idaho) | Primary |