Seasons Dental
Dentist, General Practice in Burley, ID. Organization (NPI-2).
NPI number1982157962
StatusActive
Last updated in NPPESJul 26, 2016
Details
- NPI
- 1982157962
- Entity type
- Organization (NPI-2)
- Legal business name
- Seasons Dental
- Organization subpart
- No
- Enumeration date
- Jul 26, 2016
- Last updated
- Jul 26, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 4151 | ID | Yes |
Practice location
425 N Overland AveBurley, ID 83318-3434
Phone 208-679-1679
Mailing address
425 N Overland AveBurley, ID 83318-3434
Phone 208-679-1679
Authorized official
Travis T Bodily
Owner
2086791679
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