Fairview Dental PLLC
Dentist, General Practice in Caldwell, ID. Organization (NPI-2).
NPI number1992480404
StatusActive
Last updated in NPPESJun 21, 2023
Details
- NPI
- 1992480404
- Entity type
- Organization (NPI-2)
- Legal business name
- Fairview Dental PLLC
- Organization subpart
- No
- Enumeration date
- Jun 21, 2023
- Certification date
- Jun 21, 2023
- Last updated
- Jun 21, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
329 E Logan StCaldwell, ID 83605-4863
Phone 208-459-3388
Mailing address
624 3rd St SNampa, ID 83651-3840
Phone 208-965-9415
Authorized official
Sean Wasden
Coo
2089659415
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