| Trademark Dental | |
|
115 N. Plymouth Ave. New Plymouth ID 83655 | |
| (208) 278-9900 | |
| Not Available |
| Full Name | Trademark Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 115 N. Plymouth Ave., New Plymouth, Idaho |
| Authorized Official Name and Position | Tyler Robb (OWNER) |
| Authorized Official Contact | 2082789900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trademark Dental Po Box 3 New Plymouth ID 83655-0003 Ph: (208) 278-9900 | Trademark Dental 115 N. Plymouth Ave. New Plymouth ID 83655 Ph: (208) 278-9900 |
| NPI Number | 1861793796 |
|---|---|
| Provider Enumeration Date | 11/09/2010 |
| Last Update Date | 11/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861793796 | NPI | - | NPPES |
| 9211402 | Medicaid | ID | |
| 1164682704 | Other | PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4158 (Idaho) | Primary |
| 1223G0001X | Dentist - General Practice | D9152 (Oregon) | Secondary |
Two Rivers Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 N Plymouth Avenue, New Plymouth, ID 83655 Phone: 208-549-1732 Fax: 208-549-4050 |