Alligator Pediatric Dentistry ,pllc | |
2805 Eagle Drive Ammon ID 83406 | |
(208) 542-1333 | |
(208) 552-7296 |
Full Name | Alligator Pediatric Dentistry ,pllc |
---|---|
Speciality | Dentist - Pediatric Dentistry |
Location | 2805 Eagle Drive, Ammon, Idaho |
Authorized Official Name and Position | Randy G. Smith (OWNER) |
Authorized Official Contact | 2085421333 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Alligator Pediatric Dentistry ,pllc 2805 Eagle Drive Ammon ID 83406 Ph: (208) 542-1333 | Alligator Pediatric Dentistry ,pllc 2805 Eagle Drive Ammon ID 83406 Ph: (208) 542-1333 |
NPI Number | 1679747588 |
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Provider Enumeration Date | 04/22/2008 |
Last Update Date | 04/08/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679747588 | NPI | - | NPPES |
8041268000 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | D3257PD (Idaho) | Primary |
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