Provider Demographics
NPI:1639572456
Name:TODAYS DENTAL CARE WENDELL LLC
Entity Type:Organization
Organization Name:TODAYS DENTAL CARE WENDELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-536-5441
Mailing Address - Street 1:119 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-6147
Mailing Address - Country:US
Mailing Address - Phone:208-324-8861
Mailing Address - Fax:208-324-8899
Practice Address - Street 1:410 N IDAHO ST
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:ID
Practice Address - Zip Code:83355-5038
Practice Address - Country:US
Practice Address - Phone:208-536-5441
Practice Address - Fax:208-536-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty