Black Canyon Dental P C

NPI #1679732804 in Emmett, Idaho

Provider Information

NPI Number: 1679732804
Entity Type: Organization
Organization Name: Black Canyon Dental P C
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 3, 2008
Last Updated: Jun 5, 2008

Practice Location

Address: 1110 S WASHINGTON AVE
City: Emmett
State: Idaho
ZIP Code: 83617-3535
Phone: (208) 365-3860

Authorized Official

Name: MR. SHON D ROOKS, D.D.S.
Title: PRESIDENT
Phone: (208) 365-3860

Specialties & Taxonomy Codes

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

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