Clock Tower Dental PA
Dentist, General Practice in Caldwell, ID. Organization (NPI-2).
NPI number1720128432
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1720128432
- Entity type
- Organization (NPI-2)
- Legal business name
- Clock Tower Dental PA
- Organization subpart
- No
- Enumeration date
- Feb 8, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | D3237 | ID | Yes |
Practice location
4105 Clock Tower AveCaldwell, ID 83607-5006
Phone 208-455-9498
Mailing address
4105 Clock Tower AveCaldwell, ID 83607-5006
Phone 208-455-9498
Authorized official
Darin R Mooso
Dentist
2084559498
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