| Kootenai Family Dental, Pa | |
|
1420 Lincoln Way Suite 200 Coeur Dalene ID 83814 | |
| (208) 664-8283 | |
| (208) 667-0794 |
| Full Name | Kootenai Family Dental, Pa |
|---|---|
| Speciality | Dentist |
| Location | 1420 Lincoln Way, Coeur Dalene, Idaho |
| Authorized Official Name and Position | Robert L Wilder (DENTIST) |
| Authorized Official Contact | 2086648283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kootenai Family Dental, Pa 1420 Lincoln Way Suite 200 Coeur Dalene ID 83814 Ph: (208) 664-8283 | Kootenai Family Dental, Pa 1420 Lincoln Way Suite 200 Coeur Dalene ID 83814 Ph: (208) 664-8283 |
| NPI Number | 1942317664 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 10/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942317664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3794 (Idaho) | Primary |