| Excellence In Dentistry Pa | |
|
2515 Channing Way Idaho Falls ID 83404-7516 | |
| (208) 529-4321 | |
| (208) 529-8609 |
| Full Name | Excellence In Dentistry Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2515 Channing Way, Idaho Falls, Idaho |
| Authorized Official Name and Position | Duane Kent Godfrey (DENTIST) |
| Authorized Official Contact | 2085294321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Excellence In Dentistry Pa 2515 Channing Way Idaho Falls ID 83404-7516 Ph: (208) 529-4321 | Excellence In Dentistry Pa 2515 Channing Way Idaho Falls ID 83404-7516 Ph: (208) 529-4321 |
| NPI Number | 1881602266 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 12/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881602266 | NPI | - | NPPES |
| 807539000 | Medicaid | ID | |
| 000755500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1637 (Idaho) | Primary |
| 1223G0001X | Dentist - General Practice | D3983 (Idaho) | Secondary |
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