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Contact Information

POTLATCH FAMILY DENTAL, PC
225 6TH STREET
POTLATCH, ID83855
 Phone: 208-875-0441
 Fax: 208-875-0972
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for POTLATCH FAMILY DENTAL PC · (Female)

NPI # 1245515832
Status Active
Credentials
Entity Individual
Enumeration date 10/15/2011
Last updated 10/15/2011 - About 15 years ago
Sole proprietor 1 Not specified
Identifiers
  • ID License # D3984
  • ID Medicaid 8075010
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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