Channing Way Dental Care
NPI #1376555292 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1376555292
- Entity Type
- Organization
- Organization Name
- Channing Way Dental Care
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Aug 12, 2006
- Last Updated
- Mar 25, 2008
Practice Location
- Address
- 2205 CHANNING WAY
- Address 2
- SUITE B
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-8016
- Phone
- (208) 529-3660
Authorized Official
- Name
- DR. GLADE L. PETERSON, D.M.D.
- Title
- OWNER/PARTNER
- Phone
- (208) 529-3660
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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