Idaho Falls Dental Group

NPI #1497803696 in Idaho Falls, Idaho

Provider Information

NPI Number: 1497803696
Entity Type: Organization
Organization Name: Idaho Falls Dental Group
Primary Specialty: Dentist
Enumeration Date: Jan 7, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 2300 E 17TH ST
City: Idaho Falls
State: Idaho
ZIP Code: 83404-6504
Phone: (208) 525-8383

Authorized Official

Name: TRACY LARSEN
Title: OFFICE MANAGER
Phone: (208) 525-8383

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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