Club 32 Dental Caldwell Pllc

NPI #1033796305 in Caldwell, Idaho

Provider Information

NPI Number: 1033796305
Entity Type: Organization
Organization Name: Club 32 Dental Caldwell Pllc
Primary Specialty: Dentist - General Practice
Enumeration Date: Mar 24, 2021
Last Updated: Mar 10, 2022

Practice Location

Address: 1916 ELLIS AVE
City: Caldwell
State: Idaho
ZIP Code: 83605-4811
Phone: (208) 466-2456

Authorized Official

Name: DR. KIM KELLER, DDS
Title: OWNER
Phone: (208) 506-3233

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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