| Pheasant Cove Dental | |
|
702 Center St W Kimberly ID 83341 | |
| (208) 423-6444 | |
| (208) 423-6903 |
| Full Name | Pheasant Cove Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 702 Center St W, Kimberly, Idaho |
| Authorized Official Name and Position | Kent J Allen (OWNER) |
| Authorized Official Contact | 2084236444 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pheasant Cove Dental 702 Center Street West Po Box B Kimberly ID 83341 Ph: (208) 423-6444 | Pheasant Cove Dental 702 Center St W Kimberly ID 83341 Ph: (208) 423-6444 |
| NPI Number | 1770769325 |
|---|---|
| Provider Enumeration Date | 01/14/2008 |
| Last Update Date | 01/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770769325 | NPI | - | NPPES |
| 000876700 | Medicaid | ID | |
| 9201818 | Other | ID | SMILES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1767 (California) | Primary |
Infinity Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 622 Center St W, Kimberly, ID 83341 Phone: 208-423-5001 Fax: 208-423-4867 |