Provider Demographics
NPI:1033985197
Name:PAUL CONCIDINE DDS PLLC
Entity Type:Organization
Organization Name:PAUL CONCIDINE DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCIDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-339-4854
Mailing Address - Street 1:1330 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2138
Mailing Address - Country:US
Mailing Address - Phone:208-339-4854
Mailing Address - Fax:
Practice Address - Street 1:1537 2ND AVE S
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2919
Practice Address - Country:US
Practice Address - Phone:208-642-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental