Avondale Dental Center, LLC

NPI #1558887067 in Coeur D'alene, Idaho

Provider Information

NPI Number: 1558887067
Entity Type: Organization
Organization Name: Avondale Dental Center, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: AVONDALE DENTAL CENTER LLC DBA ELEMENT
Primary Specialty: Dentist
Enumeration Date: Aug 16, 2017
Last Updated: Aug 16, 2017

Practice Location

Address: 700 IRONWOOD DR
Address 2: #366
City: Coeur D'alene
State: Idaho
ZIP Code: 83814
Phone: (208) 664-2160

Authorized Official

Name: MR. JAMES ROBSON, DDS
Title: AUTHORIZED OFFICIAL
Phone: (208) 772-4066

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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