Coeur D Alene Family Dentisrty

NPI #1144640509 in Coeur D Alene, Idaho

Provider Information

NPI Number: 1144640509
Entity Type: Organization
Organization Name: Coeur D Alene Family Dentisrty
Primary Specialty: Dentist
Enumeration Date: Apr 23, 2014
Last Updated: Apr 23, 2014

Practice Location

Address: 2201 N GOVERNMENT WAY
Address 2: SUITE G
City: Coeur D Alene
State: Idaho
ZIP Code: 83814-3658
Phone: (208) 664-9129

Authorized Official

Name: MR. TYLER SCOFIELD MORTON
Title: CONSULTANT
Phone: (208) 626-2625

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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