Organization · NPI-2

Affordable Family Dentistry PC

Dentist, General Practice · Idaho Falls, ID

NPI number1245560945
StatusActive
Last updated in NPPESOct 20, 2023

Details

NPI
1245560945
Entity type
Organization (NPI-2)
Legal business name
Affordable Family Dentistry PC
Organization subpart
No
Enumeration date
Jan 4, 2010
Certification date
Oct 20, 2023
Last updated
Oct 20, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General PracticeD-4216IDYes

Practice location

1400 E 17th St
Idaho Falls, ID 83404-6269

Phone 208-881-9177 · Fax 866-767-0878

Mailing address

1400 E 17th St
Idaho Falls, ID 83404-6269

Phone 208-881-9177 · Fax 866-767-0878

Authorized official

Tracy Dean Jenkins
President
2088819177

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