Provider Demographics
NPI:1225298656
Name:AES POST FALLS
Entity Type:Organization
Organization Name:AES POST FALLS
Other - Org Name:ACCESS ENDODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSD
Authorized Official - Phone:208-262-2620
Mailing Address - Street 1:602 N CALGARY CT
Mailing Address - Street 2:SUITE 301
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4000
Mailing Address - Country:US
Mailing Address - Phone:208-262-2620
Mailing Address - Fax:208-262-2621
Practice Address - Street 1:602 N CALGARY CT
Practice Address - Street 2:SUITE 301
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4000
Practice Address - Country:US
Practice Address - Phone:208-262-2620
Practice Address - Fax:208-262-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3925-EN1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty