Provider Demographics
NPI:1851697114
Name:TWIN FALLS DENTAL PLLC
Entity Type:Organization
Organization Name:TWIN FALLS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-733-2621
Mailing Address - Street 1:PO BOX 5559
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-5559
Mailing Address - Country:US
Mailing Address - Phone:208-733-2621
Mailing Address - Fax:208-733-1086
Practice Address - Street 1:788 EASTLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6856
Practice Address - Country:US
Practice Address - Phone:208-733-2621
Practice Address - Fax:208-733-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4257261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental