Provider Demographics
NPI:1821762949
Name:UNIAT DENTISTRY INC
Entity Type:Organization
Organization Name:UNIAT DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:UNIAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-459-0113
Mailing Address - Street 1:2884 S BROOKWATER LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5423
Mailing Address - Country:US
Mailing Address - Phone:208-867-9360
Mailing Address - Fax:208-459-7831
Practice Address - Street 1:1913 S KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4829
Practice Address - Country:US
Practice Address - Phone:208-459-0113
Practice Address - Fax:208-459-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental