Burley Family Dental | |
2200 Park Ave Ste 2 Burley ID 83318-2186 | |
(208) 878-6684 | |
Not Available |
Full Name | Burley Family Dental |
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Speciality | Clinic/center - Dental |
Location | 2200 Park Ave Ste 2, Burley, Idaho |
Authorized Official Name and Position | Tayne Peterson (SOLE MBR) |
Authorized Official Contact | 2086704428 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Burley Family Dental 2200 Park Ave Ste 2 Burley ID 83318-2186 Ph: (208) 878-6684 | Burley Family Dental 2200 Park Ave Ste 2 Burley ID 83318-2186 Ph: (208) 878-6684 |
NPI Number | 1942936406 |
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Provider Enumeration Date | 07/27/2022 |
Last Update Date | 09/07/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942936406 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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Idaho Orthodontic-burley Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1408 Pomerelle Ave, Suite E, Burley, ID 83318 Phone: 208-678-2738 Fax: 208-378-2731 | |
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