Sandpoint Dental Cosmetics, Pllc | |
30336 Highway 200 Suite A Ponderay ID 83852-9775 | |
(208) 255-1255 | |
(208) 263-0490 |
Full Name | Sandpoint Dental Cosmetics, Pllc |
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Speciality | Dentist - General Practice |
Location | 30336 Highway 200, Ponderay, Idaho |
Authorized Official Name and Position | Joseph Johnson (DOCTOR) |
Authorized Official Contact | 2082551255 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Sandpoint Dental Cosmetics, Pllc 30336 Highway 200 Suite A Ponderay ID 83852-9775 Ph: (208) 255-1255 | Sandpoint Dental Cosmetics, Pllc 30336 Highway 200 Suite A Ponderay ID 83852-9775 Ph: (208) 255-1255 |
NPI Number | 1083933741 |
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Provider Enumeration Date | 05/20/2010 |
Last Update Date | 02/21/2013 |
Identifier | Type | State | Issuer |
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1083933741 | NPI | - | NPPES |
1831385590 | Other | ID | NPI TYPE ONE |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | D4103 (Idaho) | Primary |