| Summit Dental Care Group, Pllc | |
|
285 Canyon Crest Dr Twin Falls ID 83301-5359 | |
| (208) 733-9999 | |
| (208) 733-9699 |
| Full Name | Summit Dental Care Group, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 285 Canyon Crest Dr, Twin Falls, Idaho |
| Authorized Official Name and Position | Alisa Frame (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 2087339999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Dental Care Group, Pllc 285 Canyon Crest Drive Twin Falls ID 83301 Ph: (208) 733-9999 | Summit Dental Care Group, Pllc 285 Canyon Crest Dr Twin Falls ID 83301-5359 Ph: (208) 733-9999 |
| NPI Number | 1871753608 |
|---|---|
| Provider Enumeration Date | 06/16/2008 |
| Last Update Date | 02/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871753608 | NPI | - | NPPES |
| 807190600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D3892 (Idaho) | Primary |
| 122300000X | Dentist | D4455 (Idaho) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
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