| Id Specialty Dental Services, Pllc | |
|
2140 W Riverstone Dr Coeur D Alene ID 83814-4967 | |
| (208) 667-3209 | |
| Not Available |
| Full Name | Id Specialty Dental Services, Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2140 W Riverstone Dr, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Charlotte Dasch (DIRECTOR OF CREDENTIALING & PROV RE) |
| Authorized Official Contact | 5046380303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Specialty Dental Services, Pllc 1610 54th Ave N Ste 205 Nashville TN 37209-1442 Ph: () - | Id Specialty Dental Services, Pllc 2140 W Riverstone Dr Coeur D Alene ID 83814-4967 Ph: (208) 667-3209 |
| NPI Number | 1952086845 |
|---|---|
| Provider Enumeration Date | 06/19/2023 |
| Last Update Date | 06/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952086845 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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