| Identistry Pllc | |
|
115 S Main St Homedale ID 83628-3415 | |
| (208) 869-2243 | |
| Not Available |
| Full Name | Identistry Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 115 S Main St, Homedale, Idaho |
| Authorized Official Name and Position | Jared M Martin (CEO) |
| Authorized Official Contact | 2088692243 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Identistry Pllc 15111 Kings Row Rd Caldwell ID 83607-8371 Ph: (208) 869-2243 | Identistry Pllc 115 S Main St Homedale ID 83628-3415 Ph: (208) 869-2243 |
| NPI Number | 1477144038 |
|---|---|
| Provider Enumeration Date | 01/27/2021 |
| Last Update Date | 01/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477144038 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Terry Reilly Health Services Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 108 E Idaho Ave, Homedale, ID 83628 Phone: 208-337-3189 Fax: 208-466-5359 |