NPI 1033560578

Id Dental Associates, P.C.

Organisation Dentist Idaho Falls, ID

Practice location

Address: 2818 S 25th E, Idaho Falls, ID 83404
Phone: (208) 243-8391
Fax: (208) 243-8391
Mailing address: PO Box 3189, Syracuse, NY 13220-3189

Authorised official

Name: Jason Bertollini
Title: Prs
Phone: (866) 273-8204

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D-4206 (ID)

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Registry record

NPI: 1033560578
Entity type: Organization
NPI issued: 27 Jun 2016
Record last updated: 27 Jun 2016

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.