| Russell Guymon Orthodontics, Pa | |
|
333 S Woodruff Ave Idaho Falls ID 83401-4322 | |
| (208) 529-3500 | |
| Not Available |
| Full Name | Russell Guymon Orthodontics, Pa |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 333 S Woodruff Ave, Idaho Falls, Idaho |
| Authorized Official Name and Position | Russell J Guymon (OWNER/ORTHODONTIST) |
| Authorized Official Contact | 2085293500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell Guymon Orthodontics, Pa 333 S Woodruff Ave Idaho Falls ID 83401-4322 Ph: (208) 529-3500 | Russell Guymon Orthodontics, Pa 333 S Woodruff Ave Idaho Falls ID 83401-4322 Ph: (208) 529-3500 |
| NPI Number | 1194097402 |
|---|---|
| Provider Enumeration Date | 02/01/2012 |
| Last Update Date | 02/01/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194097402 | NPI | - | NPPES |
| 10584378285 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D-4402-OR (Idaho) | Primary |
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