| Kootenai Family Dental | |
|
1420 Lincoln Way Suite 200 Coeur D Alene ID 83814-2390 | |
| (208) 664-8283 | |
| Not Available |
| Full Name | Kootenai Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 1420 Lincoln Way, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Alexis Larose (PRESIDENT/DENTIST) |
| Authorized Official Contact | 2086648283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kootenai Family Dental 1420 Lincoln Way Suite 200 Coeur D Alene ID 83814-2390 Ph: (208) 664-8283 | Kootenai Family Dental 1420 Lincoln Way Suite 200 Coeur D Alene ID 83814-2390 Ph: (208) 664-8283 |
| NPI Number | 1578815130 |
|---|---|
| Provider Enumeration Date | 10/08/2012 |
| Last Update Date | 10/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578815130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D4454 (Idaho) | Primary |
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