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119 Country Ln Jerome ID 83338-6147 | |
| (208) 324-8861 | |
| (208) 324-8899 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 119 Country Ln, Jerome, Idaho |
| Authorized Official Name and Position | Don S Wyatt (OWNER) |
| Authorized Official Contact | 2083248861 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
119 Country Ln Jerome ID 83338-6147 Ph: (208) 324-8861 | 119 Country Ln Jerome ID 83338-6147 Ph: (208) 324-8861 |
| NPI Number | 1104229913 |
|---|---|
| Provider Enumeration Date | 10/07/2014 |
| Last Update Date | 10/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104229913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4052 (Idaho) | Primary |
Jerome Toothtown Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1555 S Lincoln Ave, Jerome, ID 83338 Phone: 208-539-9876 | |
William H Lloyd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 119 Country Ln, Jerome, ID 83338 Phone: 208-324-8861 Fax: 208-324-8899 | |
Smiles 4 Kids Jerome Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 115 East Rose St., Jerome, ID 83338 Phone: 208-324-7415 |