Ikdo State Street LLC
NPI #1932683752 in Garden City, Idaho
Provider Information
- NPI Number
- 1932683752
- Entity Type
- Organization
- Organization Name
- Ikdo State Street LLC
- Primary Specialty
- Dentist - Orthodontics and Dentofacial Orthopedics
- Enumeration Date
- Sep 18, 2018
- Last Updated
- Sep 18, 2018
Practice Location
- Address
- 9209 W STATE ST
- City
- Garden City
- State
- Idaho
- ZIP Code
- 83714
- Phone
- (208) 388-1111
Authorized Official
- Name
- JAYCIE BIRCH
- Title
- OFFICE MANAGER
- Phone
- (208) 388-1111
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - Pediatric Dentistry — Pediatric Dentistry |
| Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics |
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