| Id Oms Specialty Dental Services, Pllc | |
|
1859 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-2661 | |
| (208) 667-5565 | |
| Not Available |
| Full Name | Id Oms Specialty Dental Services, Pllc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1859 N Lakewood Dr Ste 101, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Charlotte Dasch (DIRECTOR OF CREDENTIALING &PR) |
| Authorized Official Contact | 5046380303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Oms Specialty Dental Services, Pllc 1610 54th Ave N Ste 205 Nashville TN 37209-1442 Ph: (615) 678-0759 | Id Oms Specialty Dental Services, Pllc 1859 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-2661 Ph: (208) 667-5565 |
| NPI Number | 1245096338 |
|---|---|
| Provider Enumeration Date | 02/26/2024 |
| Last Update Date | 02/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245096338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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