| Sandpoint Dental Cosmetics, Pllc | |
|
30336 Highway 200 Suite A Ponderay ID 83852-9775 | |
| (208) 255-1255 | |
| (208) 263-0490 |
| Full Name | Sandpoint Dental Cosmetics, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 30336 Highway 200, Ponderay, Idaho |
| Authorized Official Name and Position | Joseph Johnson (DOCTOR) |
| Authorized Official Contact | 2082551255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandpoint Dental Cosmetics, Pllc 30336 Highway 200 Suite A Ponderay ID 83852-9775 Ph: (208) 255-1255 | Sandpoint Dental Cosmetics, Pllc 30336 Highway 200 Suite A Ponderay ID 83852-9775 Ph: (208) 255-1255 |
| NPI Number | 1083933741 |
|---|---|
| Provider Enumeration Date | 05/20/2010 |
| Last Update Date | 02/21/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083933741 | NPI | - | NPPES |
| 1831385590 | Other | ID | NPI TYPE ONE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4103 (Idaho) | Primary |