| Northwest Endodontics Pc | |
|
509 W Hanley Ste 202 Coeur D Alene ID 83815 | |
| (208) 667-8622 | |
| (208) 664-2402 |
| Full Name | Northwest Endodontics Pc |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 509 W Hanley, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Timothy Walther Penberthy (OWNER) |
| Authorized Official Contact | 2086678622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Endodontics Pc 509 W Hanley Ste 202 Coeur D Alene ID 83815 Ph: (208) 667-8622 | Northwest Endodontics Pc 509 W Hanley Ste 202 Coeur D Alene ID 83815 Ph: (208) 667-8622 |
| NPI Number | 1972660769 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 08/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972660769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | D1930EN (Idaho) | Primary |
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