| Implants Northwest | |
|
1859 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-2661 | |
| (208) 667-5565 | |
| (208) 765-9633 |
| Full Name | Implants Northwest |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1859 N Lakewood Dr, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Daniel Cullum (PRESIDENT) |
| Authorized Official Contact | 2086675565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Implants Northwest 1859 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-2661 Ph: (208) 667-5565 | Implants Northwest 1859 N Lakewood Dr Ste 101 Coeur D Alene ID 83814-2661 Ph: (208) 667-5565 |
| NPI Number | 1386020550 |
|---|---|
| Provider Enumeration Date | 08/10/2015 |
| Last Update Date | 08/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386020550 | NPI | - | NPPES |
| D-3149-OS | Other | ID | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D-3149-OS (Idaho) | Primary |
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