Eagle Rock Dental Care PLLC
Dentist, General Practice in Idaho Falls, ID. Organization (NPI-2).
NPI number1326395385
StatusActive
Last updated in NPPESAug 24, 2012
Details
- NPI
- 1326395385
- Entity type
- Organization (NPI-2)
- Legal business name
- Eagle Rock Dental Care PLLC
- Organization subpart
- Yes
- Enumeration date
- Aug 9, 2012
- Last updated
- Aug 24, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | D3063 | ID | Yes |
| 1223G0001X | Dentist, General Practice | D4138 | ID | |
| 1223G0001X | Dentist, General Practice | D1890 | ID | |
| 1223G0001X | Dentist, General Practice | D4036 | ID | |
| 1223G0001X | Dentist, General Practice | D4369 | ID | |
| 1223G0001X | Dentist, General Practice | D1608 | ID |
Practice location
2205 Channing Way Ste BIdaho Falls, ID 83404-8016
Phone 208-529-3660 · Fax 208-529-3666
Mailing address
2205 Channing Way Ste BIdaho Falls, ID 83404-8016
Phone 208-529-3660 · Fax 208-529-3666
Authorized official
Trudee L Chapple
Office Administrator
2085235400
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