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Oral Surgery, Dental Specialists

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AVALON DENTAL PC

Dental Care Facilities

Kuna, Idaho

Provider NPI: 1962850933

Organization Information:
Organization Name:  AVALON DENTAL PC
Organization is not Subpart
Authorized Official:  JAMES D. GRANT  OWNER  208-6292800

Practice Location:
672 E WYTHE CREEK CT STE 101 KUNA, ID 83634 US
Tel: 208-629-2800  Fax: 208-629-2801

Business Mailing Address:
672 E WYTHE CREEK CT STE 101 KUNA, ID 83634 US
Tel: 208-629-2800  Fax: 208-629-2801

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QD0000XAmbulatory Health Care Facilities
Clinic/Center
Dental
IDD3875

Other Provider Identifiers:

IssuerNumberStateType
INDIVIDUAL PROVIDER1447345491ID01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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