Provider Demographics
NPI:1891304556
Name:BIRCHWOOD DENTAL, PLLC
Entity Type:Organization
Organization Name:BIRCHWOOD DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLAN
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:HOLDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-509-0278
Mailing Address - Street 1:3325 N TEN MILE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6951
Mailing Address - Country:US
Mailing Address - Phone:208-228-5499
Mailing Address - Fax:855-204-6128
Practice Address - Street 1:3325 N TEN MILE RD STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6951
Practice Address - Country:US
Practice Address - Phone:208-228-5499
Practice Address - Fax:855-204-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty