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1619 N Whitley Dr Fruitland ID 83619-2162 | |
| (208) 452-4444 | |
| (208) 452-3322 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1619 N Whitley Dr, Fruitland, Idaho |
| Authorized Official Name and Position | Michael D Payne (PRESIDENT) |
| Authorized Official Contact | 2083714445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3289 N Towerbridge Way Meridian ID 83646-8347 Ph: (208) 884-4466 | 1619 N Whitley Dr Fruitland ID 83619-2162 Ph: (208) 452-4444 |
| NPI Number | 1184108706 |
|---|---|
| Provider Enumeration Date | 09/19/2018 |
| Last Update Date | 04/16/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184108706 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
Childrens Dentistry Of Fruitland Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1950 N Whitley Dr, Fruitland, ID 83619 Phone: 541-709-5500 Fax: 208-467-5199 |