| Burley Family Dental | |
|
2200 Park Ave Ste 2 Burley ID 83318-2186 | |
| (208) 878-6684 | |
| Not Available |
| Full Name | Burley Family Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2200 Park Ave Ste 2, Burley, Idaho |
| Authorized Official Name and Position | Tayne Peterson (SOLE MBR) |
| Authorized Official Contact | 2086704428 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Burley Family Dental 2200 Park Ave Ste 2 Burley ID 83318-2186 Ph: (208) 878-6684 | Burley Family Dental 2200 Park Ave Ste 2 Burley ID 83318-2186 Ph: (208) 878-6684 |
| NPI Number | 1942936406 |
|---|---|
| Provider Enumeration Date | 07/27/2022 |
| Last Update Date | 09/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942936406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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