| Fairview Dental | |
|
329 E Logan St Caldwell ID 83605-4863 | |
| (208) 459-3388 | |
| (208) 453-9295 |
| Full Name | Fairview Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 329 E Logan St, Caldwell, Idaho |
| Authorized Official Name and Position | Keith L Stucki (MANAGER) |
| Authorized Official Contact | 2084593388 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairview Dental 329 E Logan St Caldwell ID 83605-4863 Ph: (208) 459-3388 | Fairview Dental 329 E Logan St Caldwell ID 83605-4863 Ph: (208) 459-3388 |
| NPI Number | 1457704009 |
|---|---|
| Provider Enumeration Date | 07/19/2016 |
| Last Update Date | 07/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457704009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3315 (Idaho) | Primary |
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