Provider Demographics
NPI:1164583761
Name:ARMSTRONG, DAMON TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:TAYLOR
Last Name:ARMSTRONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W PACIFIC ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2034
Mailing Address - Country:US
Mailing Address - Phone:208-785-3310
Mailing Address - Fax:208-785-3393
Practice Address - Street 1:625 W PACIFIC ST STE 4
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2034
Practice Address - Country:US
Practice Address - Phone:208-785-3310
Practice Address - Fax:208-785-3393
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID35401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice