Grand Peaks Dental | |
72 S 1st E Ste 102 Rexburg ID 83440-1902 | |
(208) 356-4900 | |
(208) 359-1600 |
Full Name | Grand Peaks Dental |
---|---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 72 S 1st E Ste 102, Rexburg, Idaho |
Authorized Official Name and Position | Lori K Sessions (CEO) |
Authorized Official Contact | 2083564900 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Grand Peaks Dental Po Box 18 Saint Anthony ID 83445-0018 Ph: (208) 356-4900 | Grand Peaks Dental 72 S 1st E Ste 102 Rexburg ID 83440-1902 Ph: (208) 356-4900 |
NPI Number | 1558123356 |
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Provider Enumeration Date | 01/26/2024 |
Last Update Date | 05/02/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558123356 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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