Provider Demographics
NPI:1164539383
Name:SAWTOOTH DENTAL PLLC
Entity Type:Organization
Organization Name:SAWTOOTH DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DELUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-4515
Mailing Address - Street 1:1437 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3250
Mailing Address - Country:US
Mailing Address - Phone:208-733-4515
Mailing Address - Fax:208-733-2757
Practice Address - Street 1:1437 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3250
Practice Address - Country:US
Practice Address - Phone:208-733-4515
Practice Address - Fax:208-733-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4141122300000X
IDD32631223G0001X
IDD45821223G0001X
IDD41371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty