| Lake City Dental Specialties, Pc | |
|
1322 W Kathleen Ave Ste 2 Coeur D Alene ID 83815-7365 | |
| (208) 664-7300 | |
| (208) 664-7333 |
| Full Name | Lake City Dental Specialties, Pc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 1322 W Kathleen Ave Ste 2, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Shaun Michael Whitney (PRESIDENT) |
| Authorized Official Contact | 2086647300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake City Dental Specialties, Pc 1322 W Kathleen Ave Ste 2 Coeur D Alene ID 83815-7365 Ph: (208) 664-7300 | Lake City Dental Specialties, Pc 1322 W Kathleen Ave Ste 2 Coeur D Alene ID 83815-7365 Ph: (208) 664-7300 |
| NPI Number | 1356693915 |
|---|---|
| Provider Enumeration Date | 10/07/2012 |
| Last Update Date | 10/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356693915 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | D4420EN (Idaho) | Secondary |
| 1223P0300X | Dentist - Periodontics | D4420PE (Idaho) | Primary |
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