| Pediatric Dental Center Of North Idaho | |
|
1717 Lincoln Way Suite 205 Coeur D Alene ID 83814-2556 | |
| (208) 667-3556 | |
| (208) 066-4681 |
| Full Name | Pediatric Dental Center Of North Idaho |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1717 Lincoln Way, Coeur D Alene, Idaho |
| Authorized Official Name and Position | John M Ukich (PRESIDENT) |
| Authorized Official Contact | 2086673556 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dental Center Of North Idaho 1717 Lincoln Way Suite 205 Coeur D Alene ID 83814-2556 Ph: (208) 667-3556 | Pediatric Dental Center Of North Idaho 1717 Lincoln Way Suite 205 Coeur D Alene ID 83814-2556 Ph: (208) 667-3556 |
| NPI Number | 1295906063 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 03/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295906063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D1656 (Idaho) | Primary |
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