NPI 1003010877
Southridge Dental
Practice location
- Address
- 2811 12th Ave Rd, Nampa, ID 83686-8482
- Phone
- (208) 466-2458
- Fax
- (208) 465-6303
Authorised official
- Name
- Robert Alan Pratt
- Title
- Dentist
- Phone
- (208) 466-2458
Registered specialties
General Practice Dentistry
Primary
Registry record
- NPI
- 1003010877
- Entity type
- Organization
- NPI issued
- 13 Jun 2007
- Record last updated
- 22 Aug 2020
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.