NPI 1225577224

Southway Orthodontics PLLC

Organisation Customized Equipment (DME) Lewiston, ID

Practice location

Address: 77 Southway Ave Suite D, Lewiston, ID 83501-2203
Phone: (208) 798-4427
Fax: (208) 743-4807

Authorised official

Name: Bret Christensen
Title: Dr
Phone: (208) 791-0428

Registered specialties

Customized Equipment (DME) Primary

Suppliers Taxonomy 332BC3200X Licence D 3069 OR (ID)

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Registry record

NPI: 1225577224
Entity type: Organization
NPI issued: 23 Feb 2017
Record last updated: 23 Feb 2017

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.