| Grand Peaks Dental | |
|
72 S 1st E Ste 102 Rexburg ID 83440-1902 | |
| (208) 356-4900 | |
| (208) 359-1600 |
| Full Name | Grand Peaks Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 72 S 1st E Ste 102, Rexburg, Idaho |
| Authorized Official Name and Position | Lori K Sessions (CEO) |
| Authorized Official Contact | 2083564900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Peaks Dental Po Box 18 Saint Anthony ID 83445-0018 Ph: (208) 624-4100 | Grand Peaks Dental 72 S 1st E Ste 102 Rexburg ID 83440-1902 Ph: (208) 356-4900 |
| NPI Number | 1558123356 |
|---|---|
| Provider Enumeration Date | 01/26/2024 |
| Last Update Date | 02/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558123356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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