| Ivory Edge, P.c. | |
|
1323 Highway 2 Suite 301 Sandpoint ID 83864-5210 | |
| (208) 263-1412 | |
| Not Available |
| Full Name | Ivory Edge, P.c. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1323 Highway 2, Sandpoint, Idaho |
| Authorized Official Name and Position | Benjamin D Hull (OWNER) |
| Authorized Official Contact | 2082631412 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivory Edge, P.c. 1323 Highway 2 Suite 301 Sandpoint ID 83864-5210 Ph: (208) 263-1412 | Ivory Edge, P.c. 1323 Highway 2 Suite 301 Sandpoint ID 83864-5210 Ph: (208) 263-1412 |
| NPI Number | 1447636220 |
|---|---|
| Provider Enumeration Date | 08/04/2015 |
| Last Update Date | 08/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447636220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-4660 (Idaho) | Primary |
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