Kootenai Dental Group, Llc

NPI 1265532261 - Dentist - 1223G0001X

NPI Details
NPI 1265532261
Enumeration Date 09/22/2006
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name DELWYN LEE DELWYN
Position CEO
Phone (208) 762-8750
Fax (208) 762-2530
Practice Location
555 W. CANFIELD AVENUE
COEUR D'ALENE ID, 83815-7892, US
Phone (208) 762-8750
Fax (208) 762-2530
Business Location
555 W. CANFIELD AVENUE
COEUR D'ALENE ID, 83815-7892, US
Phone (208) 762-8750
Fax (208) 762-2530
Toxanomy
Taxonomy Code 1223G0001X
License State Idaho
License Number ID03049
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According to our database, Kootenai Dental Group, Llc NPI is 1265532261, taxonomy code is 1223G0001X and license number is ID03049, license state is located at Idaho. Kootenai Dental Group, Llc physically located at 555 W. Canfield Avenue, Coeur D'alene ID, 83815-7892. NPI Number 1033115704 has the healthcare provider type.

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1265532261 NPI number is provided on an as is basis without warranty of any kind. 1265532261 is maintained by the National Plan & Provider Enumeration System. The contents of Kootenai Dental Group, Llc are for informational purposes only.