| Ikdo State Street Llc | |
|
9209 W State St Garden City ID 83714 | |
| (208) 388-1111 | |
| Not Available |
| Full Name | Ikdo State Street Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 9209 W State St, Garden City, Idaho |
| Authorized Official Name and Position | Jaycie Birch (OFFICE MANAGER) |
| Authorized Official Contact | 2083881111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ikdo State Street Llc 9209 W State St Garden City ID 83714 Ph: (208) 388-1111 | Ikdo State Street Llc 9209 W State St Garden City ID 83714 Ph: (208) 388-1111 |
| NPI Number | 1932683752 |
|---|---|
| Provider Enumeration Date | 09/18/2018 |
| Last Update Date | 09/18/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932683752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |