| Premier Dentistry Of Eagle | |
|
467 S Rivershore Ln Eagle ID 83616-4978 | |
| (208) 938-1247 | |
| Not Available |
| Full Name | Premier Dentistry Of Eagle |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 467 S Rivershore Ln, Eagle, Idaho |
| Authorized Official Name and Position | Shane Steven Porter (DENTIST/OWNER) |
| Authorized Official Contact | 2089381247 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Dentistry Of Eagle 467 S. Rivershore Lane Eagle ID 83616 Ph: (208) 938-1247 | Premier Dentistry Of Eagle 467 S Rivershore Ln Eagle ID 83616-4978 Ph: (208) 938-1247 |
| NPI Number | 1649620139 |
|---|---|
| Provider Enumeration Date | 06/15/2016 |
| Last Update Date | 06/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649620139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D-4002 (Idaho) | Primary |
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