| Potlatch Family Dental, Pc | |
|
225 6th Street Potlatch ID 83855 | |
| (208) 875-0441 | |
| (208) 875-0972 |
| Full Name | Potlatch Family Dental, Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 225 6th Street, Potlatch, Idaho |
| Authorized Official Name and Position | Ammon Michael Pitt (DENTIST) |
| Authorized Official Contact | 2088750441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Potlatch Family Dental, Pc Po Box 601 Potlatch ID 83855-0601 Ph: (208) 875-0441 | Potlatch Family Dental, Pc 225 6th Street Potlatch ID 83855 Ph: (208) 875-0441 |
| NPI Number | 1245515832 |
|---|---|
| Provider Enumeration Date | 10/15/2011 |
| Last Update Date | 10/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245515832 | NPI | - | NPPES |
| 8075010 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3984 (Idaho) | Primary |
Potlatch Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 225 6th Street, Potlatch, ID 83855 Phone: 208-875-0441 Fax: 208-875-0972 |