Russell Guymon Orthodontics, Pa

NPI 1194097402 - Dentist - 1223X0400X

NPI Details
NPI 1194097402
Enumeration Date 02/01/2012
Last Updated 02/01/2012
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name RUSSELL J RUSSELL
Position OWNER/ORTHODONTIST
Phone (208) 529-3500
Fax
Practice Location
333 S WOODRUFF AVE
IDAHO FALLS ID, 83401-4322, US
Phone (208) 529-3500
Fax
Business Location
333 S WOODRUFF AVE
IDAHO FALLS ID, 83401-4322, US
Phone (208) 529-3500
Fax
Toxanomy
Taxonomy Code 1223X0400X
License State Idaho
License Number D-4402-OR
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According to our database, Russell Guymon Orthodontics, Pa NPI is 1194097402, taxonomy code is 1223X0400X and license number is D-4402-OR, license state is located at Idaho. Russell Guymon Orthodontics, Pa physically located at 333 S Woodruff Ave, Idaho Falls ID, 83401-4322. NPI Number 1033115704 has the healthcare provider type.

1194097402 NPI number is provided on an as is basis without warranty of any kind. 1194097402 is maintained by the National Plan & Provider Enumeration System. The contents of Russell Guymon Orthodontics, Pa are for informational purposes only.