| Southridge Dental | |
|
2811 12th Ave Rd Nampa ID 83686 | |
| (208) 466-2458 | |
| (208) 465-6303 |
| Full Name | Southridge Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2811 12th Ave Rd, Nampa, Idaho |
| Authorized Official Name and Position | Todd Lawrence Squires (OWNER) |
| Authorized Official Contact | 8016823097 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southridge Dental 2811 12th Ave Rd Nampa ID 83686 Ph: (208) 466-2458 | Southridge Dental 2811 12th Ave Rd Nampa ID 83686 Ph: (208) 466-2458 |
| NPI Number | 1457593584 |
|---|---|
| Provider Enumeration Date | 04/06/2009 |
| Last Update Date | 05/27/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457593584 | NPI | - | NPPES |
| 1063894145 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
Southridge Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2811 12th Ave Rd, Nampa, ID 83686 Phone: 208-466-2458 Fax: 208-465-6303 | |
Dba Ronald J. Albright Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1208 11th St S, Nampa, ID 83651 Phone: 208-463-1800 | |
Jmj Holding Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 914 12th Ave Rd Ste 102, Nampa, ID 83686 Phone: 208-996-3010 | |
Onsite Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 524 E Fujii Dr, Nampa, ID 83686 Phone: 844-667-4834 Fax: 208-376-3616 | |
Christian C. Cusimano Dds, Ms, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 345 W Iowa Ave, Nampa, ID 83686 Phone: 208-467-4362 Fax: 208-463-9080 | |
Russell C. Pool, Dmd, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 12th Ave Rd, Nampa, ID 83686 Phone: 208-467-2545 Fax: 208-466-3607 | |
Scott R Gardner Dds Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2065 12th Ave Rd, Nampa, ID 83686 Phone: 208-466-3239 |