Provider Demographics
NPI:1376922179
Name:AMERICAN FALLS DENTAL
Entity Type:Organization
Organization Name:AMERICAN FALLS DENTAL
Other - Org Name:FALLS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STERZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-904-3496
Mailing Address - Street 1:239 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83211-1235
Mailing Address - Country:US
Mailing Address - Phone:208-904-3496
Mailing Address - Fax:208-904-3514
Practice Address - Street 1:239 IDAHO ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83211-1235
Practice Address - Country:US
Practice Address - Phone:208-904-3496
Practice Address - Fax:208-904-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4634122300000X
IDD3963122300000X
IDD1967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002639200Medicaid
ID807472000Medicaid
ID1811396708OtherNPI
ID1467543595OtherNPI
ID1760566384OtherNPI