| Ikdo Star Llc | |
|
12190 W Evely Pines Ln Star ID 83669-6126 | |
| (208) 884-4466 | |
| Not Available |
| Full Name | Ikdo Star Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12190 W Evely Pines Ln, Star, Idaho |
| Authorized Official Name and Position | Michael D Payne (OWNER) |
| Authorized Official Contact | 2088844466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ikdo Star Llc 3289 N Towerbridge Way Meridian ID 83646-8347 Ph: () - | Ikdo Star Llc 12190 W Evely Pines Ln Star ID 83669-6126 Ph: (208) 884-4466 |
| NPI Number | 1861954026 |
|---|---|
| Provider Enumeration Date | 04/04/2019 |
| Last Update Date | 05/08/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861954026 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Secondary |
Idaho Dental Professionals, P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 N Highbrook Way Ste 102, Star, ID 83669 Phone: 208-600-0522 Fax: 208-600-0496 | |
Star Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10706 W State St, Suite 105, Star, ID 83669 Phone: 208-286-9890 Fax: 208-286-9924 |