| Id Dental Associates, P.c. | |
|
2818 S 25th E Idaho Falls ID 83404 | |
| (208) 243-8391 | |
| (208) 243-8391 |
| Full Name | Id Dental Associates, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 2818 S 25th E, Idaho Falls, Idaho |
| Authorized Official Name and Position | Jason Bertollini (PRS) |
| Authorized Official Contact | 8662738204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Dental Associates, P.c. Po Box 3189 Syracuse NY 13220-3189 Ph: (866) 273-8204 | Id Dental Associates, P.c. 2818 S 25th E Idaho Falls ID 83404 Ph: (208) 243-8391 |
| NPI Number | 1033560578 |
|---|---|
| Provider Enumeration Date | 06/27/2016 |
| Last Update Date | 06/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033560578 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D-4206 (Idaho) | Primary |
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