| Emmett Dental Group P.c. | |
|
119 N Wardwell Ave Emmett ID 83617-3040 | |
| (208) 365-6313 | |
| Not Available |
| Full Name | Emmett Dental Group P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 119 N Wardwell Ave, Emmett, Idaho |
| Authorized Official Name and Position | Warren Richard Willis (OWNER) |
| Authorized Official Contact | 2083656313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Emmett Dental Group P.c. 119 N Wardwell Ave Emmett ID 83617-3040 Ph: (208) 365-6313 | Emmett Dental Group P.c. 119 N Wardwell Ave Emmett ID 83617-3040 Ph: (208) 365-6313 |
| NPI Number | 1255577490 |
|---|---|
| Provider Enumeration Date | 12/17/2008 |
| Last Update Date | 12/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255577490 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-3635 (Idaho) | Primary |
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