Emmett Dental Group P.c. | |
119 N Wardwell Ave Emmett ID 83617-3040 | |
(208) 365-6313 | |
Not Available |
Full Name | Emmett Dental Group P.c. |
---|---|
Speciality | Dentist - General Practice |
Location | 119 N Wardwell Ave, Emmett, Idaho |
Authorized Official Name and Position | Warren Richard Willis (OWNER) |
Authorized Official Contact | 2083656313 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Emmett Dental Group P.c. 119 N Wardwell Ave Emmett ID 83617-3040 Ph: (208) 365-6313 | Emmett Dental Group P.c. 119 N Wardwell Ave Emmett ID 83617-3040 Ph: (208) 365-6313 |
NPI Number | 1255577490 |
---|---|
Provider Enumeration Date | 12/17/2008 |
Last Update Date | 12/17/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255577490 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | D-3635 (Idaho) | Primary |
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