Bluesky Dental

NPI 1073808333 - Dentist - 1223G0001X

NPI Details
NPI 1073808333
Enumeration Date 06/15/2011
Last Updated 06/15/2011
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name KEVIN C KEVIN
Position OWNER
Phone (208) 882-9111
Fax (208) 882-3279
Practice Location
2500 W A ST STE 204
MOSCOW ID, 83843-6000, US
Phone (208) 882-9111
Fax (208) 882-3279
Business Location
2500 W A ST STE 204
MOSCOW ID, 83843-6000, US
Phone (208) 882-9111
Fax (208) 882-3279
Toxanomy
Taxonomy Code 1223G0001X
License State Idaho
License Number D3597
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According to our database, Bluesky Dental NPI is 1073808333, taxonomy code is 1223G0001X and license number is D3597, license state is located at Idaho. Bluesky Dental physically located at 2500 W A St Ste 204, Moscow ID, 83843-6000. NPI Number 1033115704 has the healthcare provider type.

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1073808333 NPI number is provided on an as is basis without warranty of any kind. 1073808333 is maintained by the National Plan & Provider Enumeration System. The contents of Bluesky Dental are for informational purposes only.