Provider Demographics
NPI:1003993445
Name:SEPT, KAREN MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:SEPT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 W A ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2277
Mailing Address - Country:US
Mailing Address - Phone:208-882-9999
Mailing Address - Fax:208-882-9998
Practice Address - Street 1:1246 W A ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2277
Practice Address - Country:US
Practice Address - Phone:208-882-9999
Practice Address - Fax:208-882-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011112122300000X
IDD-4108-PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807993200Medicaid